Provider Demographics
NPI:1356488225
Name:FOSTER, CRAIG (OTRL)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2714
Mailing Address - Country:US
Mailing Address - Phone:509-965-6330
Mailing Address - Fax:509-972-0320
Practice Address - Street 1:3704 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2714
Practice Address - Country:US
Practice Address - Phone:509-965-6330
Practice Address - Fax:509-972-0320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0519860002Medicare NSC