Provider Demographics
NPI:1477909992
Name:SEAVEY, DOUGLAS (LAT, ATC, OTC, CSCS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SEAVEY
Suffix:
Gender:M
Credentials:LAT, ATC, OTC, CSCS
Other - Prefix:
Other - First Name:MAC
Other - Middle Name:
Other - Last Name:SEAVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 STATION AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2096
Mailing Address - Country:US
Mailing Address - Phone:207-249-5608
Mailing Address - Fax:
Practice Address - Street 1:19 STATION AVE APT 303
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2096
Practice Address - Country:US
Practice Address - Phone:207-249-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer