| Organization Name: | CANTON ORTHOTIC LABORATORY INC |
| NPI Number: | 1073576617 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN THOMAS SIMKO (PRESIDENT/LICENSED ORTHOTIST) |
| Mailing Address: | 2400 Wales Ave Nw Suite H Massillon |
| State: | OH US |
| Postal Code: | 446460804 |
| Phone Number: | 3308330955 |
| Fax Number: | 3308330980 |
| NPI Enumeration Date: | 04/06/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |