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General NPI Number Information
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NPI Number | 1548753262
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Entity Type | Individual
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Provider Name | SEAN P. ROACH SR. M.A.ED, ATC/L, CAA
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Gender | Male
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 3 LAUREL ST
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City | DANVERS
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State | MA
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Zip | 01923-2731
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Country | US
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Telephone | 978-578-1604
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Fax |
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Provider Business Mailing Address
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Address Line | 3 LAUREL ST
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City | DANVERS
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State | MA
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Zip | 01923-2731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AH-1401-AT
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1401-AH-AT
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License Number State | MA
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