Healthcare Provider Details

I. General information

NPI: 1548024581
Provider Name (Legal Business Name): CAITLIN MEWAR CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 12TH AVE NE
OLYMPIA WA
98506-5218
US

IV. Provider business mailing address

3508 12TH AVE NE
OLYMPIA WA
98506-5218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number61467742
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number61311103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: