Provider Demographics
NPI:1871683003
Name:CREATIVE ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:CREATIVE ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:310 TAUGHANNOCK BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3231
Mailing Address - Country:US
Mailing Address - Phone:607-277-6620
Mailing Address - Fax:607-277-2533
Practice Address - Street 1:310 TAUGHANNOCK BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3231
Practice Address - Country:US
Practice Address - Phone:607-277-6620
Practice Address - Fax:607-277-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER ORTHOPEDIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02179239Medicaid
NY0456230002Medicare NSC