Basic Information
| Provider Information | |||||||||
| NPI: | 1710429840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'KELLEY | ||||||||
| FirstName: | SEAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4220 132ND ST SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253168046 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 110TH AVE NE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256282072 | ||||||||
| FaxNumber: | 4253419056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60693079 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0364872 | 01 | WA | L & I | OTHER | 0364848 | 01 | WA | L & I | OTHER | 0364857 | 01 | WA | L & I | OTHER | 0368033 | 01 | WA | L & I | OTHER | 0364873 | 01 | WA | L & I | OTHER |