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CUSTOM PROSTHETIC LTD. NPI 1710008537


NPI Information

NPI: 1710008537
Provider Name: CUSTOM PROSTHETIC, LTD.
Classification: Anaplastologist - 229N00000X
Entity Type: Organization
Address:
705 OPERA ALY STE K
TACOMA, WA
ZIP 98402
Phone: (253) 327-1924
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CUSTOM PROSTHETIC, LTD. is an anaplastologist in Tacoma, WA. The provider is an anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA). CUSTOM PROSTHETIC, LTD. NPI is 1710008537. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

705 OPERA ALY STE K
TACOMA, WA
ZIP 98402-734
Phone: (253) 327-1924
Fax: (206) 826-1790

The provider's authorized official is Sharon A Haggerty .
The authorized official title is President, Anaplastologist and has the following contact phone number (253) 327-6192.

The enumeration date for this NPI number is 4/2/2007 and was last updated on 10/25/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1229N00000XAnaplastologistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10170345OTHERWASHINGTONLABOR & INDUSTRIES
29044017MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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