| NPI | 1255089991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL FAIRLEY CEO 769-257-1002 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 222Z00000X |
| Additional Taxonomies | 224P00000X Prosthetist |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-03-11 |