| NPI | 1053506121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVA L BLACK Owner 580-353-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OK 22498 001) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: OK 22498 001) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2008-07-16 |