Provider Demographics
NPI:1235632654
Name:MCLARTY, SETH ERIC (CPO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ERIC
Last Name:MCLARTY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:SETH
Other - Middle Name:ERIC
Other - Last Name:MCLARTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPO
Mailing Address - Street 1:3400 LATOUCHE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4603
Mailing Address - Country:US
Mailing Address - Phone:907-561-1777
Mailing Address - Fax:907-561-2157
Practice Address - Street 1:3400 LATOUCHE ST # 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1483222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist