Provider Demographics
NPI:1841639192
Name:WATERMAN, DANIEL C JR (DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:WATERMAN
Suffix:JR
Gender:M
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ELLSWORTH RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1408 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3830
Practice Address - Country:US
Practice Address - Phone:603-313-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT3692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer