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Suppliers Prosthetic/Orthotic Supplier

Provider NPI: 1174892640

Organization Information:
Organization is not Subpart
Authorized Official:  KATHY  MOELLER  PRESIDENT  541-772-3465

Practice Location:
2104 HILL WAY  MEDFORD, OR 97504-6208 US
Tel: 541-772-3465  Fax: --

Business Mailing Address:
2104 HILL WAY  MEDFORD, OR 97504-6208 US
Tel: 541-772-3465  Fax: --

NPI Information:
NPI: 1174892640
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Prosthetic/Orthotic Supplier

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 335E00000X





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