Provider Demographics
NPI:1669692497
Name:ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.
Entity type:Organization
Organization Name:ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CP, FAAOP
Authorized Official - Phone:414-257-2727
Mailing Address - Street 1:10506 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4332
Mailing Address - Country:US
Mailing Address - Phone:414-257-2727
Mailing Address - Fax:414-257-9898
Practice Address - Street 1:10506 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4332
Practice Address - Country:US
Practice Address - Phone:414-257-2727
Practice Address - Fax:414-257-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIC.P. 13071744P3200X
1744P3200X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41785600Medicaid
WIC.P. 1307OtherTAXONOMY
WI1242120001Medicare NSC