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General NPI Number Information
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NPI Number | 1689739120
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Entity Type | Organization
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Legal Business Name | SCATTER CREEK PROSTHETICS INC.
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 548 SUSSEX AVE W
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City | TENINO
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State | WA
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Zip | 98589-9341
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Country | US
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Telephone | 360-264-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 225 143RD AVE SE
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City | TENINO
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State | WA
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Zip | 98589-9604
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Country | US
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Telephone | 360-264-6553
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL GENE RUCKER
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Credential | LPO
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Telephone | 360-264-6553
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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 |
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License Number State |
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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 |
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License Number State |
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