Provider Demographics
NPI:1821576422
Name:DENNAN, SEAN MICHAEL (MOT/L)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:DENNAN
Suffix:
Gender:M
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13705 SW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6899
Mailing Address - Country:US
Mailing Address - Phone:305-776-6035
Mailing Address - Fax:
Practice Address - Street 1:210 WALKER STONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8642
Practice Address - Country:US
Practice Address - Phone:919-234-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist