Provider Demographics
NPI:1821056169
Name:SOEDER, SCOTT JOHN (LCO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOHN
Last Name:SOEDER
Suffix:
Gender:M
Credentials:LCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 3RD ST SE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3730
Mailing Address - Country:US
Mailing Address - Phone:253-840-0227
Mailing Address - Fax:253-840-1176
Practice Address - Street 1:1420 3RD ST SE
Practice Address - Street 2:SUITE 108
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3730
Practice Address - Country:US
Practice Address - Phone:253-840-0227
Practice Address - Fax:253-840-1176
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOI00000084222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist