Organization
CUSTOM PROSTHETICS & ORTHOTICS
Active
Organization
CUSTOM PROSTHETICS & ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON D HARPER (OWNER)
(870) 762-5151
Entity
Organization
Contact information
Practice address
515 N 6TH ST, BLYTHEVILLE, AR 72315-2407
(870) 762-5151
(870) 762-5158
Mailing address
606 LANES WAY, P.O. BOX 605, MANILA, AR 72442-9136
(870) 561-1818
(870) 762-5158
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PENDING
AR
Other
Enumeration date
06/03/2006
Last updated
08/22/2020
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