Provider Demographics
NPI:1093921108
Name:OLYMPIC OESD114
Entity Type:Organization
Organization Name:OLYMPIC OESD114
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALT
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-405-5843
Mailing Address - Street 1:105 NATIONAL AVE N
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3537
Mailing Address - Country:US
Mailing Address - Phone:360-405-5843
Mailing Address - Fax:360-782-5081
Practice Address - Street 1:2000 ALLEN ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-5002
Practice Address - Country:US
Practice Address - Phone:360-405-5843
Practice Address - Fax:360-782-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991231Medicaid