CUSTOM PROSTHETIC & ORTHOTIC NPI 1710147301

NPI Information

  • NPI: 1710147301
  • Provider Name: CUSTOM PROSTHETIC & ORTHOTIC
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Organization
  • Address: 801 E NORTHSIDE DR
    SUITE - D
    CLINTON, MS
    ZIP 39056
  • Phone: (601) 906-1024

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NPI Details

CUSTOM PROSTHETIC & ORTHOTIC is a prosthetic orthotic supplier in Clinton, MS. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. CUSTOM PROSTHETIC & ORTHOTIC NPI is 1710147301. The provider is registered as an organization entity type.

The provider's business location address is:

801 E NORTHSIDE DR
SUITE - D
CLINTON, MS
ZIP 39056-663
Phone: (601) 906-1024

The provider's authorized official is Johnnie Mae Owens .
The authorized official title is Owner President and has the following contact phone number (601) 906-1024.

The enumeration date for this NPI number is 6/17/2008 and was last updated on 3/15/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierMISSISSIPPIYes

What is NPI?

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This page was last updated on: 3/30/2025

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