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General NPI Number Information
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NPI Number | 1013687821
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Entity Type | Organization
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Legal Business Name | MAUGHAN PROSTHETIC & ORTHOTIC, INC.
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1805 COOKS HILL RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9072
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Country | US
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Telephone | 360-330-1602
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Fax | 360-807-4511
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Provider Business Mailing Address
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Address Line | PO BOX 1546
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City | GRAHAM
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State | WA
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Zip | 98338-1546
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Country | US
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Telephone | 360-447-0770
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Fax | 253-904-8705
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Authorized Official
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Title or Position | LCPO/OWNER
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Name | MR. JUSTIN M MAUGHAN
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Credential | LCPO
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Telephone | 360-698-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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