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General NPI Number Information
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NPI Number | 1710305420
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Entity Type | Organization
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Legal Business Name | KELIOTTMD OF SEATTLE LLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 811 1ST AVE STE 626 SUITE 626
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City | SEATTLE
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State | WA
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Zip | 98104-1434
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Country | US
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Telephone | 206-351-7516
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 E PARK DR E
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City | SEATTLE
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State | WA
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Zip | 98112-2003
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Country | US
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Telephone | 206-351-7516
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KATHRYN JANE ELLIOTT
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Credential | MD
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Telephone | 206-351-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 60308596
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License Number State | WA
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