Provider Demographics
NPI:1588938476
Name:DREW, RICHARD HARDING III (MSBE, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HARDING
Last Name:DREW
Suffix:III
Gender:M
Credentials:MSBE, ATC, LAT
Other - Prefix:
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Mailing Address - Street 1:58 FLAXFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-3375
Mailing Address - Country:US
Mailing Address - Phone:508-685-6459
Mailing Address - Fax:
Practice Address - Street 1:26 CHASE RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277-2802
Practice Address - Country:US
Practice Address - Phone:860-923-9565
Practice Address - Fax:860-923-3733
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer