Provider Demographics
NPI:1992192348
Name:HICKEY, DANIEL RYAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RYAN
Last Name:HICKEY
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 1:168 RIVER RD APT 436
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1063
Mailing Address - Country:US
Mailing Address - Phone:978-609-7415
Mailing Address - Fax:508-793-3974
Practice Address - Street 1:1 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2322
Practice Address - Country:US
Practice Address - Phone:508-793-2627
Practice Address - Fax:508-793-3974
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer