Organization
CUSTOM PROSTHETIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON A HAGGERTY M.A.M.S. (PRESIDENT, ANAPLASTOLOGIST)
(253) 327-6192
Entity
Organization
Contact information
Practice address
705 OPERA ALY STE K, TACOMA, WA 98402-3734
(253) 327-1924
(206) 826-1790
Mailing address
705 OPERA ALY STE K, TACOMA, WA 98402-3734
(253) 327-1924
(206) 826-1790
Taxonomy
Speciality
Code
Description
License number
State
229N00000X
Anaplastologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170345
LABOR & INDUSTRIES
WA
05
—
9044017
—
WA
Enumeration date
04/02/2007
Last updated
10/25/2019
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