Healthcare Provider Details

I. General information

NPI: 1770542482
Provider Name (Legal Business Name): SONYA GAY TAFOYA LCO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 5TH THOMPSON CUSTOM ORTHOTIC AND PROSTHETIC
SPOKANE WA
99202-1313
US

IV. Provider business mailing address

502 E 5TH THOMPSON CUSTOM ORTHOTIC AND PROSTHETIC
SPOKANE WA
99202-1313
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1308
  • Fax: 509-624-5537
Mailing address:
  • Phone: 509-624-1308
  • Fax: 509-624-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI00000184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: