MEDICARE: MR. JEFFREY ALAN HABICHT EMT, ATC

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	2255A2300X	Athletic Trainer
2	146N00000X	Basic Emergency Medical Technician	843514	MA

General Provider Information

NPI Number	:	1609835099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY ALAN HABICHT EMT, ATC

Provider Business Mailing Address
First Line	:	66 SPRING ST
Second Line	:	TABOR ACADEMY
City	:	MARION
State	:	MA
Zip	:	02738-1518
Country	:	US
Telephone Number	:	508-748-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 SPRING ST
Second Line	:	TABOR ACADEMY
City	:	MARION
State	:	MA
Zip	:	02738-1518
Country	:	US
Telephone Number	:	508-748-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	09/11/2025

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