Healthcare Provider Details

I. General information

NPI: 1083711063
Provider Name (Legal Business Name): TOM A PUTAANSUU M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 ENSIGN RD NE STE M1
OLYMPIA WA
98506-5065
US

IV. Provider business mailing address

3525 ENSIGN RD NE STE M1
OLYMPIA WA
98506-5065
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9733
  • Fax: 360-493-1943
Mailing address:
  • Phone: 360-491-9733
  • Fax: 360-493-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberLD00001057
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLD00001057
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00001057
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: