Provider Demographics
NPI:1124806468
Name:MCMICHEAL, GREG SCOTT (MOT)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:SCOTT
Last Name:MCMICHEAL
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6546 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8405
Mailing Address - Country:US
Mailing Address - Phone:360-682-8357
Mailing Address - Fax:
Practice Address - Street 1:785 SE BAYSHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3275
Practice Address - Country:US
Practice Address - Phone:360-279-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60575005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist