Ken Harvey

Individual provider Active NPI Athletic Trainer · Foxborough, MA

NPI 1154073450 · NPPES record last updated Jan 19, 2022

Key facts

NPI
1154073450
Entity type
Individual (NPI type 1)
Primary specialty
Athletic Trainer 2255A2300X
License
3608 (MA)
Practice address
240 Patriot PL
Foxborough, MA 02035-5100
Phone
(508) 543-4900
NPI assigned
Jan 19, 2022
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
3608MAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
TB12 LLC Athletic Trainer Past
since Jan 26, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 3608 MA Yes

Addresses

Primary practice location

240 Patriot PL
Foxborough, MA 02035-5100

Mailing address

53 Burnt Swamp Rd
Wrentham, MA 02093-1737
Phone (774) 307-3175

Electronic endpoints

TypeEndpointUseAffiliation
SOAP URL Swol123.net

Other providers in Foxborough, MA

All providers in Foxborough, MA · Athletic Trainer in Massachusetts

Sources for this page

Verify at the official NPI Registry.