Organization
SOUTH SOUND PHYSICAL & HAND THERAPY PLLC
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
111 MARKET ST NE, SUITE 108, OLYMPIA, WA 98501-1008
(360) 754-7085
(360) 754-3671
Mailing address
4220 132ND ST SE, SUITE 101, MILL CREEK, WA 98012-8999
(425) 357-9380
(425) 357-9382
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
—
WA
225XH1200X
Hand Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0164914
DEPT. OF LABOR & INDUSTRY
WA
01
—
3583413-00
OWCP
WA
01
—
7108MA
REGENCE BLUESHIELD GRP #
WA
05
—
7112980
—
WA
05
—
7683600
—
WA
05
—
9054982
—
WA
01
—
DA0695
RAILROAD MEDICARE
WA
Enumeration date
05/27/2006
Last updated
06/15/2015
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