MEDICARE: SEAN PATRICK SILLS

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	225700000X	Massage Therapist	MT000023	GA

General Provider Information

NPI Number	:	1821286709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN PATRICK SILLS

Provider Business Mailing Address
First Line	:	735 S ROUNTREE ST
Second Line	:
City	:	METTER
State	:	GA
Zip	:	30439-5121
Country	:	US
Telephone Number	:	912-687-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 S LEROY ST
Second Line	:
City	:	METTER
State	:	GA
Zip	:	30439-4631
Country	:	US
Telephone Number	:	912-687-3309
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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Directions to “ SEAN PATRICK SILLS ” Practice Location

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