Healthcare Provider Details

I. General information

NPI: 1245260843
Provider Name (Legal Business Name): SEAN DONLEY OTC, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 OXFORD LN NW
CEDAR RAPIDS IA
52405-1186
US

IV. Provider business mailing address

8100 W 78TH ST STE 230
EDINA MN
55439-2570
US

V. Phone/Fax

Practice location:
  • Phone: 319-261-0110
  • Fax:
Mailing address:
  • Phone: 952-946-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: