Healthcare Provider Details

I. General information

NPI: 1609142777
Provider Name (Legal Business Name): BENGT WALKER LCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LILLY RD NE STE A
OLYMPIA WA
98506-6100
US

IV. Provider business mailing address

208 LILLY RD NE STE A
OLYMPIA WA
98506-6100
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-1099
  • Fax: 360-459-1794
Mailing address:
  • Phone: 360-459-1099
  • Fax: 360-459-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI 60252420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: