Provider Demographics
NPI:1912151465
Name:BUSCH, KAIA (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:KAIA
Middle Name:
Last Name:BUSCH
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:KAIA
Other - Middle Name:
Other - Last Name:HALVORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPO, LPO
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:10TH FLOOR, SUITE 1040
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-625-4633
Mailing Address - Fax:206-625-4741
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:10TH FLOOR, SUITE 1040
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-625-4633
Practice Address - Fax:206-625-4741
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000070222Z00000X
WAPS00000069224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist