Provider Demographics
NPI:1801503735
Name:KAVELLA PROSTHETICS AND ORTHOTICS LLC
Entity type:Organization
Organization Name:KAVELLA PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BATOOL
Authorized Official - Middle Name:SUMMER
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPO
Authorized Official - Phone:682-390-4499
Mailing Address - Street 1:99 CHEEK SPARGER RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2204
Mailing Address - Country:US
Mailing Address - Phone:682-390-4499
Mailing Address - Fax:817-549-9460
Practice Address - Street 1:99 CHEEK SPARGER RD STE 104A
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2204
Practice Address - Country:US
Practice Address - Phone:682-390-4499
Practice Address - Fax:817-549-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier