| NPI | 1376900548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE MAFFUCCI Lead Office Administrator 503-242-9136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: CO 20166000095) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO 20166000095) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |