Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1619118106 |
---|---|
Provider Name | Mr. Michael Shawn Davis |
First Address | Olympia, WA 98506-6100 |
Second Address | Olympai, WA 98506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2009 |
Last Update Date | 29/04/2011 |