Provider Demographics
NPI:1255786877
Name:GEAREY, STEPHEN (ATC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GEAREY
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 1:105 SIMRALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1159
Mailing Address - Country:US
Mailing Address - Phone:218-820-6574
Mailing Address - Fax:
Practice Address - Street 1:105 SIMRALL BLVD
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1159
Practice Address - Country:US
Practice Address - Phone:218-820-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND472-122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer