Provider Demographics
NPI:1336191279
Name:SIROIS, RICHARD URBAIN (MS, LATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:URBAIN
Last Name:SIROIS
Suffix:
Gender:M
Credentials:MS, LATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BRIARWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260
Mailing Address - Country:US
Mailing Address - Phone:207-590-6082
Mailing Address - Fax:
Practice Address - Street 1:46 BRIARWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260
Practice Address - Country:US
Practice Address - Phone:207-590-6082
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer