| NPI | 1083492029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAIRY LLOYD Owner 314-562-3698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2023-09-22 |