Healthcare Provider Details

I. General information

NPI: 1659571081
Provider Name (Legal Business Name): MASTER'S ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 MICKELBERRY RD NW
SILVERDALE WA
98383-9195
US

IV. Provider business mailing address

9990 MICKELBERRY RD NW SUITE 104
SILVERDALE WA
98383-8531
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-7005
  • Fax: 360-698-1984
Mailing address:
  • Phone: 360-307-7005
  • Fax: 360-698-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberOI00000034
License Number StateWA

VIII. Authorized Official

Name: MR. NATHANAEL LEE FEEHAN
Title or Position: INSURANCE CONTRACTING
Credential:
Phone: 360-307-7005