Provider Demographics
NPI:1073390704
Name:SEATON, ANDREW WADE (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WADE
Last Name:SEATON
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 1:15960 HIGHWAY O
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-4604
Mailing Address - Country:US
Mailing Address - Phone:660-351-4383
Mailing Address - Fax:
Practice Address - Street 1:411 CENTRAL METHODIST SQ STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1198
Practice Address - Country:US
Practice Address - Phone:660-351-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220355312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer