Healthcare Provider Details

I. General information

NPI: 1083943245
Provider Name (Legal Business Name): INTEGRATED REHABILITATION GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 221ST PL SE SUITE 208
ISSAQUAH WA
98027-8927
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-392-4206
  • Fax: 425-392-4209
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHANNON O'KELLEY
Title or Position: PRESIDENT/OWNER
Credential: MPT
Phone: 425-316-8046