| Organization Name: | ETHERIDGE PROSTHETICS LLC |
| NPI Number: | 1023490349 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM ROBERT ETHERIDGE (PROSTHETIST) |
| Mailing Address: | 2202 Westpark Dr Suite A Norman |
| State: | OK US |
| Postal Code: | 730694033 |
| Phone Number: | 4057013733 |
| Fax Number: | 4057013752 |
| NPI Enumeration Date: | 06/23/2015 |
| NPI Last Update Date: | 11/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 224P00000X |
| License Number: | C21410 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Prosthetist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |