Organization
EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L O'NEILL (OWNER)
(503) 407-5408
Entity
Organization
Contact information
Practice address
210 IVY AVE, SUITE E, TILLAMOOK, OR 97141-2216
(503) 354-5500
Mailing address
911 MAIN ST STE 100, OREGON CITY, OR 97045-1853
(037) 655-0815
(971) 316-1553
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/13/2016
Last updated
11/01/2023
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