Organization
WILMINGTON ORTHOTICS & PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARISKA TRUESDALE (BUSINESS MANAGER)
(910) 395-5775
Entity
Organization
Contact information
Practice address
3909 OLEANDER DR STE E, WILMINGTON, NC 28403-6714
(910) 395-5775
(910) 395-5773
Mailing address
3909 OLEANDER DR STE E, WILMINGTON, NC 28403-6714
(910) 395-5775
(910) 395-5773
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0472
BCBS OF NC PROVIDER NUMBE
NC
05
—
7701282
—
NC
Enumeration date
11/01/2006
Last updated
04/13/2022
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