Provider Demographics
NPI:1952054132
Name:WALKING EAGLE, LEE COLE (ATP)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:COLE
Last Name:WALKING EAGLE
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NE TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1150
Mailing Address - Country:US
Mailing Address - Phone:760-212-5232
Mailing Address - Fax:
Practice Address - Street 1:27 NE TREMONT DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1150
Practice Address - Country:US
Practice Address - Phone:760-212-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies