| NPI | 1962133470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATIANA RECHELLE NELSON Prosthetic Orthotic Provider 702-752-8354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-06-23 |