Provider Demographics
NPI:1861773830
Name:CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR INC
Entity type:Organization
Organization Name:CENTRAL OHIO ORTHOTIC & PROSTHETIC CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-231-4256
Mailing Address - Street 1:3059 E MOUND STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2665
Mailing Address - Country:US
Mailing Address - Phone:614-231-4256
Mailing Address - Fax:614-231-0127
Practice Address - Street 1:248 BRADENTON AVENUE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-231-4256
Practice Address - Fax:614-231-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCE92437335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820553Medicaid
OH0820553Medicaid