Orthotic and Prosthetic Lab, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

213.000099 Issued in IL

Legal business name

ORTHOTIC AND PROSTHETIC LAB, INC.

Practice address

6 Emerald Ter
Suite 1
Swansea, IL 62226-2312

Phone

(618) 235-4864

NPI assigned

Dec 12, 2006

Last updated

Feb 16, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David J Osterman

Title

Owner

Phone

(314) 968-8555

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1437219078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 MARSHALL AVE",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631191924",
            "telephone_number": "314-968-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EMERALD TER",
            "address_2": "SUITE 1",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262312",
            "telephone_number": "618-235-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC AND PROSTHETIC LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "OSTERMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-968-8555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "211.000024",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "213.000099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.