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General NPI Number Information
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NPI Number | 1992743090
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Entity Type | Organization
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Legal Business Name | DOUGLASS CERT PROS & ORTHOTICS, INC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 15225 AURORA AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-6123
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Country | US
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Telephone | 206-363-7790
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Fax | 206-363-7688
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Provider Business Mailing Address
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Address Line | PO BOX 650846
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City | DALLAS
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State | TX
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Zip | 75265-0846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGULATORY COMPLIANCE ANALYST III
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Name | JENNIFER L SIMMONS
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Credential |
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Telephone | 859-594-2709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PS00000063
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License Number State | WA
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