Custom Prosthetics & Orthotics

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

PENDING Issued in AR

Legal business name

CUSTOM PROSTHETICS & ORTHOTICS

Practice address

515 N 6TH St
Blytheville, AR 72315-2407

Phone

(870) 762-5151

Fax

(870) 762-5158

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Brandon D Harper

Title

Owner

Phone

(870) 762-5151

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851339410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 LANES WAY",
            "address_2": "P.O. BOX 605",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724429136",
            "telephone_number": "870-561-1818",
            "fax_number": "870-762-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N 6TH ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723152407",
            "telephone_number": "870-762-5151",
            "fax_number": "870-762-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM PROSTHETICS & ORTHOTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-762-5151"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AR",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Crafton, SLP
• Dana Renee Craig
• Hallie Crews
• Stanley Wilson Crisler
• Kenjarvis Cross, LCSW
• Kailey Soileau Daniel, OD
• Judy Daniels, MHPP
• Peggy Darty
• Christina Davis, MED
• Kenyghatta Davis, MHPP

• Prosthetic/Orthotic Supplier in Blytheville, AR
• Providers in Blytheville, AR by specialty
• Prosthetic/Orthotic Supplier in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.