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1316971377

NPI Code Detail

MEDICARE: INTEGRATED REHABILITATION GROUP INC

MEDICARE: INTEGRATED REHABILITATION GROUP INC

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	225XH1200X	Hand Occupational Therapist		WA
2	225700000X	Massage Therapist		WA
3	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1182780006	OTHER	WA	DME
2	0191251	OTHER	WA	DEPT. OF LABOR & INDUSTRY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8930484	OTHER	WA	L&I CRIME VICTIMS

General Provider Information

NPI Number	:	1316971377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED REHABILITATION GROUP INC

Provider Business Mailing Address
First Line	:	1519 132ND ST SE
Second Line	:	SUITE A
City	:	EVERETT
State	:	WA
Zip	:	98208-7203
Country	:	US
Telephone Number	:	425-330-0633
Fax Number	:	425-338-9637

Provider Business Practice Location Address
First Line	:	22500 NE MARKETPLACE DR
Second Line	:	SUITE 204
City	:	REDMOND
State	:	WA
Zip	:	98053-2033
Country	:	US
Telephone Number	:	425-836-1034
Fax Number	:	425-836-1037

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MICHAEL SHANNON O'KELLEY
Credential	:	MPT
Telephone Number	:	425-337-9556

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/04/2007

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Directions to “INTEGRATED REHABILITATION GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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