Provider Demographics
NPI:1518110584
Name:MAXWELL PAYTON LLC
Entity Type:Organization
Organization Name:MAXWELL PAYTON LLC
Other - Org Name:MOMS IN CLOGS/POLLYWOG BABY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-782-8835
Mailing Address - Street 1:5710 NE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2004
Mailing Address - Country:US
Mailing Address - Phone:206-782-8835
Mailing Address - Fax:
Practice Address - Street 1:5710 NE 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2004
Practice Address - Country:US
Practice Address - Phone:206-782-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602361761332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies