Provider Demographics
NPI:1912230855
Name:SPECIALIZED ORTHOTIC SYSTEMS
Entity Type:Organization
Organization Name:SPECIALIZED ORTHOTIC SYSTEMS
Other - Org Name:SOS BRACING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-485-9758
Mailing Address - Street 1:4812 CRANE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5552
Mailing Address - Country:US
Mailing Address - Phone:303-485-9758
Mailing Address - Fax:
Practice Address - Street 1:4812 CRANE CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-5552
Practice Address - Country:US
Practice Address - Phone:303-485-9758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2008-000563820332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies