Provider Demographics
NPI:1235149659
Name:MASTER'S ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MASTER'S ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TY
Authorized Official - Last Name:FEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:360-307-7005
Mailing Address - Street 1:9975 MICKELBERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9195
Mailing Address - Country:US
Mailing Address - Phone:360-307-7005
Mailing Address - Fax:360-698-1984
Practice Address - Street 1:9975 MICKELBERRY RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9195
Practice Address - Country:US
Practice Address - Phone:360-307-7005
Practice Address - Fax:360-698-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9054172Medicaid
WA=========OtherTAX ID NUMBER
WA=========OtherTAX ID NUMBER