1841526258 NPI number — SHAWN J O'CONNELL DPT

Table of content: SHAWN J O'CONNELL DPT (NPI 1841526258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841526258 NPI number — SHAWN J O'CONNELL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
SHAWN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841526258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12121 HARBOUR REACH DR
Provider Second Line Business Mailing Address:
BUILDING A - STE 100
Provider Business Mailing Address City Name:
MUKILTEO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98275-5314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-493-8313
Provider Business Mailing Address Fax Number:
425-493-9614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10505 19TH AVE SE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208-4280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-570-0510
Provider Business Practice Location Address Fax Number:
408-945-4018
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT60100585 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8894942 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com