Creative Orthotic & Prosthetic Services

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

CREATIVE ORTHOTIC & PROSTHETIC SERVICES

Practice address

907 Mar Walt Dr Ste 2011
Fort Walton Beach, FL 32547-6756

Phone

(850) 226-8546

NPI assigned

Feb 1, 2011

Last updated

Feb 1, 2011By 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

Mary Mata

Title

Vice President

Phone

(850) 226-8546

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Sedillo Mata, CO

  • Specialist
  • Crestview, FL
  • NPI 1245438704
  NPD

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296518400000",
    "number": "1932405404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 MAR WALT DR STE 2011",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476756",
            "telephone_number": "850-226-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 MAR WALT DR STE 2011",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476756",
            "telephone_number": "850-226-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE ORTHOTIC & PROSTHETIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2011-02-01",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "850-226-8546"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032149400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John David Cox Jr., RN
• Jon Calvin Cox, PA
• Shane Aaron Cox
• Lauren Cozma, P.T.
• Megan Craft
• Jason Dean Creek, DPT
• Kimberly Creel
• Crena Kersey Pediatric Occupational Therapist PA
• Samuel D Critides Jr., MD
• Christian Crochet

• Prosthetic/Orthotic Supplier in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2011; 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.