Provider Demographics
NPI:1053321216
Name:KUPIEC, SEAN MICHAEL (MA, ATC, PES)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:KUPIEC
Suffix:
Gender:M
Credentials:MA, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6866 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2607
Mailing Address - Country:US
Mailing Address - Phone:315-292-0222
Mailing Address - Fax:
Practice Address - Street 1:GILLETTE STADIUM
Practice Address - Street 2:ONE PATRIOT PLACE
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1388
Practice Address - Country:US
Practice Address - Phone:508-384-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer