Provider Demographics
NPI:1891964888
Name:CRESAP ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:CRESAP ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRESAP
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:509-663-2490
Mailing Address - Street 1:630 N CHELAN AVE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6622
Mailing Address - Country:US
Mailing Address - Phone:509-663-2490
Mailing Address - Fax:509-663-2147
Practice Address - Street 1:835 E COLONIAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4617
Practice Address - Country:US
Practice Address - Phone:509-764-8500
Practice Address - Fax:509-663-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000162332B00000X
WAOI00000163332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9048216Medicaid
WA1279600001Medicare NSC