Provider Demographics
NPI:1730142381
Name:OKELLEY, MICHAEL S (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:OKELLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:425-357-9380
Mailing Address - Fax:425-357-9380
Practice Address - Street 1:1519 132ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7203
Practice Address - Country:US
Practice Address - Phone:425-337-9556
Practice Address - Fax:425-357-9186
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0010OKOtherREGENCE
WA0244842OtherDEPT OF L&I
WA4513OKOtherREGENCE BLUE SHIELD
WA8332660Medicaid
WA0148936OtherDEPT. OF LABOR & INDUSTRY
WA1591OKOtherREGENCE BLUE SHIELD
WA4289021OtherAETNA
WA5802OKOtherREGENCE BLUE SHIELD
WA8928853OtherL&I CRIME VICTIMS
WA8928854OtherL&I CRIME VICTIMS
WA650021376OtherRAILROAD MEDICARE
WA4228OKOtherREGENCE BLUE SHIELD
WA8928860OtherL&I CRIME VICTIMS
WA8930262OtherL&I CRIME VICTIMS
WA911745305-98208-B003OtherTRICARE
WA9587OKOtherREGENCE BLUE SHIELD
WA4289021OtherAETNA
WA650021376OtherRAILROAD MEDICARE
WAGAB08678Medicare PIN