Individual
MARK CHIMENTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP, LPO
Contact information
Practice address
13205 S 117TH EAST AVE, BROKEN ARROW, OK 74011-5203
(918) 456-3114
Mailing address
13205 S 117TH EAST AVE, BROKEN ARROW, OK 74011-5203
(918) 456-3114
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
44
OK
Other
Enumeration date
03/01/2007
Last updated
02/14/2008
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