Healthcare Provider Details

I. General information

NPI: 1912081860
Provider Name (Legal Business Name): AMERICAN ARTIFICIAL LIMB CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S ORCAS ST SUITE 100
SEATTLE WA
98108-2654
US

IV. Provider business mailing address

650 S ORCAS ST SUITE 100
SEATTLE WA
98108-2654
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-1222
  • Fax: 206-324-0070
Mailing address:
  • Phone: 206-324-1222
  • Fax: 206-324-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number0100000369
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS00000350
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number600104700
License Number StateWA

VIII. Authorized Official

Name: DONN OSHIRO
Title or Position: OWNER
Credential: LPO, CPO
Phone: 206-324-1222