Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT1855 | ME |
NPI | 1003256470 |
---|---|
Provider Name | Sean William Hasey |
First Address | Portland, ME 04101-2226 |
Second Address | Portland, ME 04101-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 01/07/2013 |