Provider Demographics
NPI:1437773033
Name:POOL, MCKALEB
Entity Type:Individual
Prefix:
First Name:MCKALEB
Middle Name:
Last Name:POOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 GRAFTON PL NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8941
Mailing Address - Country:US
Mailing Address - Phone:360-731-3131
Mailing Address - Fax:
Practice Address - Street 1:10777 GRAFTON PL NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8941
Practice Address - Country:US
Practice Address - Phone:360-731-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA948664456OtherUNITED HEALTHCARE