Provider Demographics
NPI:1659062552
Name:MILTENBERGER, RICHARD S JR (CPO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:MILTENBERGER
Suffix:JR
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7942 NOBLE VIEW LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9629
Mailing Address - Country:US
Mailing Address - Phone:360-628-8265
Mailing Address - Fax:
Practice Address - Street 1:7942 NOBLE VIEW LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9629
Practice Address - Country:US
Practice Address - Phone:360-628-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier