Healthcare Provider Details

I. General information

NPI: 1902070436
Provider Name (Legal Business Name): MICHELE ELIZABETH ONEILL MICHELE ONEILL LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE ONEILL MICHELE ONEILL LMP

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 RAINBOW PL 409 RAINBOW PLACE
SNOHOMISH WA
98290-1218
US

IV. Provider business mailing address

409 RAINBOW PLACE
SNOHOMISH WA
98290-9829
US

V. Phone/Fax

Practice location:
  • Phone: 206-604-1855
  • Fax: 360-863-2131
Mailing address:
  • Phone: 206-604-1855
  • Fax: 360-863-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA00016315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: