Provider Demographics
NPI:1114434032
Name:MCDERMOTT, DAVID JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MCDERMOTT
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 1:19 ST JOSEPH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1172
Mailing Address - Country:US
Mailing Address - Phone:207-316-7134
Mailing Address - Fax:
Practice Address - Street 1:BLDG. H1 JULIAN C SMITH RD.,
Practice Address - Street 2:
Practice Address - City:CAMP LEJUENE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:207-316-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT6232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer