Provider Demographics
NPI:1417209040
Name:HENSLEY, DAVID ELLIS (CPO, FAAOP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ELLIS
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:CPO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 218TH ST SW STE 301
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2180
Mailing Address - Country:US
Mailing Address - Phone:425-640-2004
Mailing Address - Fax:206-299-9445
Practice Address - Street 1:120 14TH AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3718
Practice Address - Country:US
Practice Address - Phone:253-848-2888
Practice Address - Fax:206-299-9445
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000072222Z00000X
WAPS00000071224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist