Provider Demographics
NPI:1881471530
Name:NORTHWEST ORTHOTICS AND PROSTHETICS L.L.C.
Entity type:Organization
Organization Name:NORTHWEST ORTHOTICS AND PROSTHETICS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:231-342-7272
Mailing Address - Street 1:42900 W 10 MILE RD STE A
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3271
Mailing Address - Country:US
Mailing Address - Phone:248-477-1443
Mailing Address - Fax:
Practice Address - Street 1:42900 W 10 MILE RD STE A
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3271
Practice Address - Country:US
Practice Address - Phone:248-477-1443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HELLNER & ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier