Provider Demographics
NPI:1598200149
Name:SEILER, SERENITY (BS, ATC)
Entity Type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:SEILER
Suffix:
Gender:F
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CAMPUS DR
Mailing Address - Street 2:APT. B
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-4080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 CAMPUS DR
Practice Address - Street 2:APT. B
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-4080
Practice Address - Country:US
Practice Address - Phone:620-518-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program