Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPO 2571 | VA |
NPI | 1588683577 |
---|---|
Provider Name | Benjamin Wayne Blecha |
First Address | Benkelman, NE 69021-3065 |
Second Address | Benkelman, NE 69021-3065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/01/2008 |