1841676186 NPI number — MR. JOSEPH FREDERICK BULLERT OT

Table of content: MR. JOSEPH FREDERICK BULLERT OT (NPI 1841676186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841676186 NPI number — MR. JOSEPH FREDERICK BULLERT OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLERT
Provider First Name:
JOSEPH
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OT
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:
1841676186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18504 BOTHELL WAY NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-892-2243
Provider Business Mailing Address Fax Number:
425-527-6948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18606 BOTHELL WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-892-2243
Provider Business Practice Location Address Fax Number:
425-527-6948
Provider Enumeration Date:
08/10/2015

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: 225XH1200X , 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)





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