Provider Demographics
NPI:1609835099
Name:HABICHT, JEFFREY ALAN (EMT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:HABICHT
Suffix:
Gender:M
Credentials:EMT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SPRING ST
Mailing Address - Street 2:TABOR ACADEMY
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1518
Mailing Address - Country:US
Mailing Address - Phone:508-748-2000
Mailing Address - Fax:
Practice Address - Street 1:66 SPRING ST
Practice Address - Street 2:TABOR ACADEMY
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1518
Practice Address - Country:US
Practice Address - Phone:508-748-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MA843514146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic