Provider Demographics
NPI:1063881530
Name:FIRST CHOICE ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:FIRST CHOICE ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIC PROSTHETIC PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:313-424-3032
Mailing Address - Street 1:30161 N PARK DR
Mailing Address - Street 2:APT 104
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1398
Mailing Address - Country:US
Mailing Address - Phone:313-424-3032
Mailing Address - Fax:586-439-0183
Practice Address - Street 1:19189 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2508
Practice Address - Country:US
Practice Address - Phone:866-925-2696
Practice Address - Fax:586-439-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty