Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | PT00003422 | WA |
NPI | 1962555367 |
---|---|
Provider Name | Melinda Prewitt |
First Address | Seattle, WA 98124-1584 |
Second Address | Seattle, WA 98112-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8410748 | (05) | WA |
P63714 | (02) | WA |