Organization
INTEGRATED REHABILITATION GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHANNON O'KELLEY MPT (PRESIDENT/OWNER)
(425) 316-8046
Entity
Organization
Contact information
Practice address
4220 132ND ST SE, SUITE 101, MILL CREEK, WA 98012-8999
(425) 316-8046
(425) 659-7449
Mailing address
4220 132ND ST SE, SUITE101, MILL CREEK, WA 98012-8999
(425) 316-8046
(425) 338-9637
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
WA
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112780
L&I
WA
01
—
3791726-00
OWCP
WA
05
—
7083322
—
WA
05
—
7682230
—
WA
01
—
8930484
L&I CRIME VICTIMS
WA
05
—
9055039
—
WA
01
—
CJ2801
RAILROAD MEDICARE
WA
01
—
IN5136
REGENCE BLUESHIELD GRP #
WA
Enumeration date
06/03/2006
Last updated
12/28/2023
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