Provider Demographics
NPI:1124726815
Name:WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Entity type:Organization
Organization Name:WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:503-364-6006
Mailing Address - Street 1:PO BOX 7339
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0102
Mailing Address - Country:US
Mailing Address - Phone:503-364-6006
Mailing Address - Fax:
Practice Address - Street 1:19767 SW 72ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8354
Practice Address - Country:US
Practice Address - Phone:503-364-6006
Practice Address - Fax:503-364-6046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies