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General NPI Number Information
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NPI Number | 1487148847
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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 | 06/19/2018
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 127 SW 156TH ST
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City | BURIEN
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State | WA
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Zip | 98166
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Country | US
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Telephone | 206-246-2714
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Fax | 206-246-4665
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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 | CLINIC ADMIN/CFO
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Name | KRYSTEN M EADS
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Credential |
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Telephone | 360-447-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | OI00000067
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | PS00000068
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License Number State | WA
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Taxonomy #3
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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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