Healthcare Provider Details

I. General information

NPI: 1306012083
Provider Name (Legal Business Name): OLYMPIA PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LILLY RD NE SUITE 250
OLYMPIA WA
98506-5101
US

IV. Provider business mailing address

525 LILLY RD NE SUITE 250
OLYMPIA WA
98506-5101
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8470
  • Fax: 360-413-8491
Mailing address:
  • Phone: 360-413-8470
  • Fax: 360-413-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SALLY J BAILEY
Title or Position: OPERATIONS SUPERVISOR
Credential:
Phone: 360-413-8364