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General NPI Number Information
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NPI Number | 1104204957
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1267 BELMONT WAY
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City | CLARKSTON
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State | WA
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Zip | 99403
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Country | US
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Telephone | 509-780-1132
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Fax | 509-758-8096
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Provider Business Mailing Address
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Address Line | PO BOX 663
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City | CLARKSTON
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State | WA
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Zip | 99403
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Country | US
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Telephone | 509-780-1132
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Fax | 509-758-8096
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Authorized Official
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Title or Position | OWNER
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Name | DEAN K. FLINDERS
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Credential |
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Telephone | 509-780-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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