Healthcare Provider Details

I. General information

NPI: 1184309015
Provider Name (Legal Business Name): MICHAEL O'NEAL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BELLEVUE WAY SE STE 202
BELLEVUE WA
98004-6649
US

IV. Provider business mailing address

429 14TH AVE E APT 114
SEATTLE WA
98112-4584
US

V. Phone/Fax

Practice location:
  • Phone: 425-378-1800
  • Fax:
Mailing address:
  • Phone: 253-414-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61442687
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: