Basic Information
Provider Information
NPI: 1497983597
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORBELL
FirstName: LINDA
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 BROADWAY STE 190
Address2:  
City: SEATTLE
State: WA
PostalCode: 981225371
CountryCode: US
TelephoneNumber: 2063234040
FaxNumber: 2063240943
Practice Location
Address1: 600 BROADWAY STE 190
Address2:  
City: SEATTLE
State: WA
PostalCode: 981225371
CountryCode: US
TelephoneNumber: 2063234040
FaxNumber: 2063240943
Other Information
ProviderEnumerationDate: 06/26/2009
LastUpdateDate: 06/26/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225000000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter 

No ID Information.


Home