Healthcare Provider Details

I. General information

NPI: 1285635086
Provider Name (Legal Business Name): KATHLEEN MARIAN FARRELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 5TH AVE
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

808 N 5TH AVE
SEQUIM WA
98382-3045
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-4840
  • Fax: 360-582-4801
Mailing address:
  • Phone: 360-683-5900
  • Fax: 360-582-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO25860
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-364
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60119145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: