Provider Demographics
NPI:1518610062
Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANDRE
Authorized Official - Middle Name:SHONDALE
Authorized Official - Last Name:MOSTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:225-316-5444
Mailing Address - Street 1:7754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4706
Mailing Address - Country:US
Mailing Address - Phone:252-439-7362
Mailing Address - Fax:985-256-2599
Practice Address - Street 1:316 BEL AIR BLVD STE 303
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3507
Practice Address - Country:US
Practice Address - Phone:225-316-4444
Practice Address - Fax:985-256-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier