Healthcare Provider Details

I. General information

NPI: 1679327514
Provider Name (Legal Business Name): OCC MED TWO SPOKANE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N MULLAN RD STE 100
SPOKANE VALLEY WA
99206-4045
US

IV. Provider business mailing address

1410 N MULLAN RD STE 100
SPOKANE VALLEY WA
99206-4045
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-0071
  • Fax: 509-703-7475
Mailing address:
  • Phone: 509-252-0071
  • Fax: 509-703-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ACCURSIO
Title or Position: CLINICIAN
Credential: ARNP,PMHNP
Phone: 509-252-0071