Organization
CREATIVE ORTHOTIC & PROSTHETIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SEDILLO MATA C.O. (PRESIDENT)
(850) 398-8159
Entity
Organization
Contact information
Practice address
120 E REDSTONE AVE, # C, CRESTVIEW, FL 32539-5370
(850) 398-8159
Mailing address
120 E REDSTONE AVE, # C, CRESTVIEW, FL 32539-5370
(850) 398-8159
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
FL
Other
Enumeration date
11/14/2007
Last updated
05/31/2012
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