Organization
W VA ORTHOTIC & PROSTHETIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUDREY E LETT (PRESIDENT/CEO)
(304) 256-8351
Entity
Organization
Contact information
Practice address
64 BROOKSHIRE LN, BECKLEY, WV 25801-6765
(304) 256-8351
(304) 256-8387
Mailing address
64 BROOKSHIRE LN, BECKLEY, WV 25801-6765
(304) 256-8351
(304) 256-8387
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147818000
—
WV
05
—
0147818001
—
WV
01
—
1040111
W/COMP
WV
01
—
269736
MAMSI
—
Enumeration date
06/27/2005
Last updated
08/22/2020
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