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General NPI Number Information
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NPI Number | 1154302081
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Entity Type | Individual
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Provider Name | MICHAEL JAMES POULOS OTR L CHT
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 1611 BROADWAY
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City | BELLINGHAM
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State | WA
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Zip | 98225-3039
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Country | US
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Telephone | 360-676-4263
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Fax | 360-671-3366
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Provider Business Mailing Address
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Address Line | PO BOX 1557
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City | BELLINGHAM
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State | WA
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Zip | 98227-1557
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Country | US
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Telephone | 360-676-4263
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Fax | 660-671-3366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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