Provider Demographics
NPI:1487673133
Name:KENNEDY, SEAN MITCHELL (ATC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MITCHELL
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:31 DAMON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1540
Mailing Address - Country:US
Mailing Address - Phone:860-235-3789
Mailing Address - Fax:860-395-0016
Practice Address - Street 1:929 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2143
Practice Address - Country:US
Practice Address - Phone:860-388-6511
Practice Address - Fax:860-395-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer