MEDICARE: KATHLEEN MARIAN FARRELL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO25860	OR
2	207Q00000X	Family Medicine Physician	O-364	ID
3	207Q00000X	Family Medicine Physician	OP60119145	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIAN FARRELL D.O.

Provider Business Mailing Address
First Line	:	808 N 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3045
Country	:	US
Telephone Number	:	360-683-5900
Fax Number	:	360-582-4800

Provider Business Practice Location Address
First Line	:	808 N 5TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3045
Country	:	US
Telephone Number	:	360-582-4840
Fax Number	:	360-582-4801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/02/2010

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Directions to “ KATHLEEN MARIAN FARRELL D.O.” Practice Location

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