Provider Demographics
NPI:1922067826
Name:SEELEY, MARK LOUIS (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:SEELEY
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S WACOUTA AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1632
Mailing Address - Country:US
Mailing Address - Phone:608-326-8201
Mailing Address - Fax:
Practice Address - Street 1:705 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2110
Practice Address - Country:US
Practice Address - Phone:608-357-2000
Practice Address - Fax:608-357-2231
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer