Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CP002270 | CO |
NPI | 1063618684 |
---|---|
Provider Name | Wayne Lew |
First Address | Westminster, CO 80234-1150 |
Second Address | Denver, CO 80206-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |