Provider Demographics
NPI:1962014100
Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANDRE
Authorized Official - Middle Name:SHONDALE
Authorized Official - Last Name:MOSTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:225-316-5444
Mailing Address - Street 1:7754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4706
Mailing Address - Country:US
Mailing Address - Phone:225-243-9736
Mailing Address - Fax:985-256-2599
Practice Address - Street 1:1050 N FLOWOOD DR STE B4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9738
Practice Address - Country:US
Practice Address - Phone:769-777-7440
Practice Address - Fax:985-256-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1143Other1143