Provider Demographics
NPI:1669896973
Name:SEATTLE ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:SEATTLE ORTHOTICS AND PROSTHETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:253-840-0606
Mailing Address - Street 1:120 14TH AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3718
Mailing Address - Country:US
Mailing Address - Phone:253-840-0606
Mailing Address - Fax:
Practice Address - Street 1:6405 218TH ST SW
Practice Address - Street 2:SUITE 304
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2180
Practice Address - Country:US
Practice Address - Phone:425-620-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000071335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier