| NPI | 1619096005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY L O'NEILL Owner 503-704-5408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA 602608675) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: WA 602608675) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-11-01 |