Provider Demographics
NPI:1902005986
Name:ASELAGE ORTHOTIC SERVICES
Entity Type:Organization
Organization Name:ASELAGE ORTHOTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ASELAGE
Authorized Official - Suffix:
Authorized Official - Credentials:CO,LO
Authorized Official - Phone:361-854-2355
Mailing Address - Street 1:1001 LOUISIANA AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2861
Mailing Address - Country:US
Mailing Address - Phone:361-854-2355
Mailing Address - Fax:
Practice Address - Street 1:1001 LOUISIANA AVE STE 304
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2861
Practice Address - Country:US
Practice Address - Phone:361-854-2355
Practice Address - Fax:361-854-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier