Provider Demographics
NPI:1699887380
Name:MCLAURY, MIKELL (ATC)
Entity type:Individual
Prefix:
First Name:MIKELL
Middle Name:
Last Name:MCLAURY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEWITT AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3600
Mailing Address - Country:US
Mailing Address - Phone:425-252-3908
Mailing Address - Fax:425-252-7940
Practice Address - Street 1:2000 HEWITT AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3600
Practice Address - Country:US
Practice Address - Phone:425-252-3908
Practice Address - Fax:425-252-7940
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer