Organization
PROSTHETIC ORTHOTIC CENTER LTE
Active
Other names
Pink Ribbon Mastectomy Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH RUTH LOTZ CFM, RFM (OWNER/ V.P.)
(715) 845-2800
Entity
Organization
Contact information
Practice address
1108 S 17TH AVE, WAUSAU, WI 54401-5709
(715) 845-2800
(715) 845-2855
Mailing address
1108 S 17TH AVE, WAUSAU, WI 54401-5709
(715) 845-2800
(715) 845-2855
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41782800
—
WI
Enumeration date
08/31/2006
Last updated
07/10/2013
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