MEDICARE: SEAL ROCK ASSOCIATES LLC

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	261QX0100X	Occupational Medicine Clinic/Center	36535	ME
2	261QP2000X	Physical Therapy Clinic/Center	36535	ME
3	235Z00000X	Speech-Language Pathologist	36535	ME
4	314000000X	Skilled Nursing Facility	36312	ME

General Provider Information

NPI Number	:	1417939612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAL ROCK ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	88 HARBOR DRIVE
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072
Country	:	US
Telephone Number	:	207-283-3646
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 HARBOR DRIVE
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072
Country	:	US
Telephone Number	:	207-283-3646
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KENNETH BOWDEN
Credential	:
Telephone Number	:	207-874-2700

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/13/2007

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Directions to “SEAL ROCK ASSOCIATES LLC ” Practice Location

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