Healthcare Provider Details

I. General information

NPI: 1124332515
Provider Name (Legal Business Name): JUSTIN WILLIAMS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LILLY RD SE STE 100
OLYMPIA WA
98501-2105
US

IV. Provider business mailing address

530 LILLY RD SE STE 100
OLYMPIA WA
98501-2105
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-0565
  • Fax: 360-486-0551
Mailing address:
  • Phone: 360-486-0565
  • Fax: 360-486-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: