Provider Demographics
NPI:1174936819
Name:FIELD, JUSTIN O (ATC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:O
Last Name:FIELD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STOCKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1636
Mailing Address - Country:US
Mailing Address - Phone:207-409-4213
Mailing Address - Fax:
Practice Address - Street 1:1 STOCKMAN AVE
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1636
Practice Address - Country:US
Practice Address - Phone:207-409-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT5182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer