Provider Demographics
NPI:1124332515
Name:WILLIAMS, JUSTIN (CPO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LILLY RD SE STE 100
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2105
Mailing Address - Country:US
Mailing Address - Phone:360-486-0565
Mailing Address - Fax:360-486-0551
Practice Address - Street 1:530 LILLY RD SE STE 100
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2105
Practice Address - Country:US
Practice Address - Phone:360-486-0565
Practice Address - Fax:360-486-0551
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist