Healthcare Provider Details

I. General information

NPI: 1710429840
Provider Name (Legal Business Name): SEAN O'KELLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 110TH AVE NE SUITE 110
BELLEVUE WA
98004-5828
US

IV. Provider business mailing address

4220 132ND ST SE SUITE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 425-628-2072
  • Fax: 425-341-9056
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-338-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60693079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: