Provider Demographics
NPI:1346315553
Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS R
Entity type:Organization
Organization Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-436-2611
Mailing Address - Street 1:8451 GARVEY DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3355
Mailing Address - Country:US
Mailing Address - Phone:919-850-9170
Mailing Address - Fax:919-850-9171
Practice Address - Street 1:8451 GARVEY DR
Practice Address - Street 2:SUITE 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3355
Practice Address - Country:US
Practice Address - Phone:919-850-9170
Practice Address - Fax:919-850-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier