Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C19724 | WA |
NPI | 1952331597 |
---|---|
Provider Name | Mrs. Pamela S Counsell |
First Address | Monroe, WA 98272-1706 |
Second Address | Monroe, WA 98272-1030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C19724 | BOC ORTHOTIC FITTER (01) | WA |
VA00013204 | PHARMACY TECHNICIAN (01) | WA |