Organization
ORTHOPEDIC BRACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN S WILKINS C..O. (PRESIDENT)
(321) 639-0277
Entity
Organization
Contact information
Practice address
836 EXECUTIVE LN, SUITE 110, ROCKLEDGE, FL 32955-3597
(321) 639-0277
(321) 639-0143
Mailing address
836 EXECUTIVE LN, SUITE 110, ROCKLEDGE, FL 32955-3597
(321) 639-0277
(321) 639-0143
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ORT 93
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M0109
BLUE CROSS BLUE SHIELD SU
FL
Enumeration date
12/08/2005
Last updated
08/22/2020
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