Provider Demographics
NPI:1417096694
Name:ENTENMANN, KARL W (CPO)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:W
Last Name:ENTENMANN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 S CEDAR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2308
Mailing Address - Country:US
Mailing Address - Phone:253-572-1282
Mailing Address - Fax:253-572-1175
Practice Address - Street 1:34709 9TH AVE S
Practice Address - Street 2:SUITE A-100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8722
Practice Address - Country:US
Practice Address - Phone:253-952-3887
Practice Address - Fax:253-927-3058
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000004224P00000X
WAOI00000003222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist