MEDICARE: MR. JAMES A SEALS C.PED, RTO, CFO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist
2	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1528213956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A SEALS C.PED, RTO, CFO

Provider Business Mailing Address
First Line	:	1481 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-0000
Country	:	US
Telephone Number	:	310-988-4198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1481 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-0000
Country	:	US
Telephone Number	:	310-988-4198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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