Provider Demographics
NPI:1508329475
Name:KASPERBAUER-MCCOOL, SEAN ELBY (LMP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ELBY
Last Name:KASPERBAUER-MCCOOL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 6TH ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-610-7830
Mailing Address - Fax:
Practice Address - Street 1:1010 6TH ST.
Practice Address - Street 2:SUITE A
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-610-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60828438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist