Basic Information
| Provider Information | |||||||||
| NPI: | 1245422369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UYEJI | ||||||||
| FirstName: | STACY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 BROADWAY | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063234040 | ||||||||
| FaxNumber: | 2063240943 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 BROADWAY | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063234040 | ||||||||
| FaxNumber: | 2063240943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Z00000X | OI00000185 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
ID Information
| ID | Type | State | Issuer | Description | 9036963 | 05 | WA | MEDICAID |