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General NPI Number Information
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NPI Number | 1902115561
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Entity Type | Organization
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Legal Business Name | SEASHORE POINT
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 100 ALDEN ST
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1456
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Country | US
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Telephone | 508-487-0771
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Fax | 508-487-2967
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Provider Business Mailing Address
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Address Line | 100 ALDEN ST
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1456
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Country | US
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Telephone | 508-487-0771
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Fax | 508-487-2967
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KEVIN COMICK
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Credential |
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Telephone | 508-487-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 1923
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License Number State | MA
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