=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336209758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEILA C LALLY, DO, PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 01/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22180 OLYMPIC COLLEGE WAY NW SUITE 204
-----------------------------------------------------
City | POULSBO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98370-6664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-697-6547
-----------------------------------------------------
Fax | 360-697-9277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22180 OLYMPIC COLLEGE WAY NW SUITE 204
-----------------------------------------------------
City | POULSBO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98370-6664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-697-6547
-----------------------------------------------------
Fax | 360-697-9277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHEILA CAROLYN LALLY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 360-697-6547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | OP00001442
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------