Provider Demographics
NPI:1871028902
Name:LITTLE, BRIAN T (CPO)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:T
Last Name:LITTLE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5809
Mailing Address - Country:US
Mailing Address - Phone:219-791-9200
Mailing Address - Fax:
Practice Address - Street 1:1673 WESTBROOK PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3068
Practice Address - Country:US
Practice Address - Phone:336-765-2425
Practice Address - Fax:336-765-8370
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X
CPO03738224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist