Provider Demographics
NPI:1871091025
Name:ASSISTIVE TECHNOLOGY PROFESSIONAL'S
Entity type:Organization
Organization Name:ASSISTIVE TECHNOLOGY PROFESSIONAL'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CORTLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:310-899-0800
Mailing Address - Street 1:5325 BEECH RD STE 23
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1800
Mailing Address - Country:US
Mailing Address - Phone:301-899-0800
Mailing Address - Fax:301-899-0900
Practice Address - Street 1:5325 BEECH RD STE 23
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1800
Practice Address - Country:US
Practice Address - Phone:310-899-0800
Practice Address - Fax:301-899-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment