Provider Demographics
NPI:1326518226
Name:SEQUEIRA, MARIA ALISON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALISON
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1769
Mailing Address - Country:US
Mailing Address - Phone:319-389-6722
Mailing Address - Fax:
Practice Address - Street 1:1594 CHARLESTON DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1769
Practice Address - Country:US
Practice Address - Phone:319-389-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT79502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer