Healthcare Provider Details

I. General information

NPI: 1538397047
Provider Name (Legal Business Name): CARYN P EARL LCPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EASTLAKE AVE E UW O&P CLINIC
SEATTLE WA
98109
US

IV. Provider business mailing address

501 EASTLAKE AVE E UW O&P CLINIC
SEATTLE WA
98109
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4026
  • Fax: 202-842-8427
Mailing address:
  • Phone: 206-598-4026
  • Fax: 202-842-8427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCPO002069
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI60444179
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS60444370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: