| NPI | 1033537964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY GAY WATSON Owner 858-483-4247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: CA KK410893) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2019-01-17 |