Healthcare Provider Details

I. General information

NPI: 1609835099
Provider Name (Legal Business Name): JEFFREY ALAN HABICHT EMT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SPRING ST TABOR ACADEMY
MARION MA
02738-1518
US

IV. Provider business mailing address

66 SPRING ST TABOR ACADEMY
MARION MA
02738-1518
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-2000
  • Fax:
Mailing address:
  • Phone: 508-748-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number843514
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: