Provider Demographics
NPI:1710429840
Name:O'KELLEY, SEAN (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:O'KELLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:425-316-8046
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:110 110TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5828
Practice Address - Country:US
Practice Address - Phone:425-628-2072
Practice Address - Fax:425-341-9056
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60693079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0364872OtherL & I
WA0364848OtherL & I
WA0364857OtherL & I
WA0368033OtherL & I
WA0364873OtherL & I
WA0364848OtherL & I
WA0364872OtherL & I
WA0364857OtherL & I
WA0368033OtherL & I
WAG8960475Medicare PIN