Provider Demographics
NPI:1548217631
Name:SOUTH SOUND PHYSICAL & HAND THERAPY PLLC
Entity Type:Organization
Organization Name:SOUTH SOUND PHYSICAL & HAND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:O'KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:425-316-8046
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:111 MARKET ST NE
Practice Address - Street 2:SUITE 108
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1008
Practice Address - Country:US
Practice Address - Phone:360-754-7085
Practice Address - Fax:360-754-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
225XH1200X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0164914OtherDEPT. OF LABOR & INDUSTRY
WA0164914OtherL&I CRIME VICTIMS
WADA0695OtherRAILROAD MEDICARE
WA3583413-00OtherOWCP
WA7108MAOtherREGENCE BLUESHIELD GRP #
WA9054982Medicaid
WA7683600Medicaid
WA7112980Medicaid
WA0164914OtherL&I CRIME VICTIMS