# EPIC PROSTHETICS AND ORTHOTICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629722889
- **Authorized official:** JAKE COBURN DAVIS CPO, MSPO (OWNER/CLINICAL MANAGER)
- **Authorized official phone:** (801) 820-0045

## Contact information

- **Practice address:** 635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
- **Practice address phone:** (801) 820-0087
- **Practice address fax:** (801) 820-2852
- **Mailing address:** 635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
- **Mailing address phone:** (801) 820-0087
- **Mailing address fax:** (801) 820-2852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 222Z00000X | Orthotist | — | NULL | — |
| 222Z00000X | Orthotist | — | — | — |
| 224P00000X | Prosthetist | — | NULL | — |
| 224P00000X | Prosthetist | — | — | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 02/07/2022
- **Last updated:** 12/09/2022