Organization
CUSTOM PROSTHETIC & ORTHOTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOHNNIE MAE OWENS CHILD CARE (OWNER PRESIDENT)
(601) 906-1024
Entity
Organization
Contact information
Practice address
801 E NORTHSIDE DR, SUITE - D, CLINTON, MS 39056-3663
(601) 906-1024
Mailing address
801 E NORTHSIDE DR, SUITE - D, CLINTON, MS 39056-3663
(601) 906-1024
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MS
Other
Enumeration date
06/17/2008
Last updated
03/15/2012
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