Provider Demographics
NPI:1710110689
Name:SHIPPEN, GARTH (LO)
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:
Last Name:SHIPPEN
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 43RD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5453
Mailing Address - Country:US
Mailing Address - Phone:425-251-3227
Mailing Address - Fax:425-277-4315
Practice Address - Street 1:401 S 43RD ST STE 140
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5453
Practice Address - Country:US
Practice Address - Phone:425-251-3227
Practice Address - Fax:425-277-4315
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist