| NPI | 1649922428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAJE LAKE Provider 352-509-6359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2022-01-22 |
| Last Update Date | 2022-01-22 |