Healthcare Provider Details

I. General information

NPI: 1871925552
Provider Name (Legal Business Name): CODY MCDONALD LCPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 BRIDGEPORT WAY W STE 204
LAKEWOOD WA
98499-8000
US

IV. Provider business mailing address

7308 BRIDGEPORT WAY W STE 204
LAKEWOOD WA
98499-8000
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-4749
  • Fax:
Mailing address:
  • Phone: 253-588-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI60374061
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS60374073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: