Provider Demographics
NPI:1710969324
Name:ABC PROSTHETICS AND ORTHOTICS DP OCOEE INC
Entity Type:Organization
Organization Name:ABC PROSTHETICS AND ORTHOTICS DP OCOEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-341-5873
Mailing Address - Street 1:10131 W COLONIAL DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4221
Mailing Address - Country:US
Mailing Address - Phone:407-523-0495
Mailing Address - Fax:407-522-5078
Practice Address - Street 1:10131 W COLONIAL DR
Practice Address - Street 2:UNIT 1
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4221
Practice Address - Country:US
Practice Address - Phone:407-523-0495
Practice Address - Fax:407-522-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR41335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2591OtherBLUE CROSS BLUE SHIELD
FLM2591OtherBLUE CROSS BLUE SHIELD