1588865893 NPI number — MRS. MARY CLAFFIE SECOR PT

Table of content: MRS. MARY CLAFFIE SECOR PT (NPI 1588865893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588865893 NPI number — MRS. MARY CLAFFIE SECOR PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SECOR
Provider First Name:
MARY
Provider Middle Name:
CLAFFIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588865893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 CRANBERRY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-255-5925
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 LONG POND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 20 CAPE COD HOSPITAL REHAB CENTER AT FONTAINE MED
Provider Business Practice Location Address City Name:
HARWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-247-9750
Provider Business Practice Location Address Fax Number:
508-247-9778
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8063 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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