Healthcare Provider Details

I. General information

NPI: 1902213861
Provider Name (Legal Business Name): J DANIEL KELLEHER RT (R) (MR) ARRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 06/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ROY ST # 457
SEATTLE WA
98109-4018
US

IV. Provider business mailing address

24 ROY ST # 457
SEATTLE WA
98109-4018
US

V. Phone/Fax

Practice location:
  • Phone: 206-289-0572
  • Fax:
Mailing address:
  • Phone: 206-289-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number286250
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number286250
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number60473309
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number60473309
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: