Provider Demographics
NPI:1619305190
Name:SEATTLE ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:SEATTLE ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO, FA
Authorized Official - Phone:425-640-2004
Mailing Address - Street 1:6405 218TH ST SW
Mailing Address - Street 2:SUITE 304
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 1:6405 218TH ST SW
Practice Address - Street 2:SUITE 304
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2180
Practice Address - Country:US
Practice Address - Phone:425-640-2004
Practice Address - Fax:206-299-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee