Provider Demographics
NPI:1598008807
Name:MCCOY, SETH WILLIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:WILLIAM
Last Name:MCCOY
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 1:33 S MAINE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046
Mailing Address - Country:US
Mailing Address - Phone:857-363-1528
Mailing Address - Fax:
Practice Address - Street 1:22 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461-9303
Practice Address - Country:US
Practice Address - Phone:857-363-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT# 4802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer