Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1477897783 |
---|---|
Provider Name | Stacy Pedegana |
First Address | Everett, WA 98203-2200 |
Second Address | Everett, WA 98203-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 27/11/2012 |