Organization
ORTHOTIC AND PROSTHETIC LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID J OSTERMAN (OWNER)
(314) 968-8555
Entity
Organization
Contact information
Practice address
777 S NEW BALLAS RD, SUITE 116, SAINT LOUIS, MO 63141-8705
(314) 567-7775
Mailing address
748 MARSHALL AVE, SAINT LOUIS, MO 63119-1924
(314) 968-8555
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
211.000024
IL
335E00000X
Prosthetic/Orthotic Supplier
Primary
213.000099
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621818608
—
MO
Enumeration date
12/13/2006
Last updated
02/16/2017
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