Provider Demographics
NPI:1720612450
Name:HAILS, SEAN C (CP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:C
Last Name:HAILS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S CEDAR ST STE 202
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2303
Mailing Address - Country:US
Mailing Address - Phone:253-572-1282
Mailing Address - Fax:253-572-1175
Practice Address - Street 1:1901 S CEDAR ST STE 202
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2303
Practice Address - Country:US
Practice Address - Phone:253-572-1282
Practice Address - Fax:253-572-1175
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS60906975224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist