Provider Demographics
NPI:1992108922
Name:SCANLON, JAMES DANIEL (ATC, NREMT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:SCANLON
Suffix:
Gender:M
Credentials:ATC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NORMAN LN
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-5740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1178
Practice Address - Country:US
Practice Address - Phone:508-839-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer