Active NPI
Tara Lynn Siesel, ATC
- Athletic Trainer
- Durham, NC
National Provider Identifier
1215697222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2701
- Practice address
- 110 Whitford Dr
Durham, NC 27708-9982 - Phone
- (207) 807-6731
- NPI assigned
- Dec 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2701 | NC | Primary |
Addresses
Primary practice location
110 Whitford Dr
Durham, NC 27708-9982
Mailing address
182 Cedar Elm Rd
Durham, NC 27713-7262
Phone (207) 807-6731
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2701 | NC | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639872000000",
"number": "1215697222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "182 CEDAR ELM RD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277137262",
"telephone_number": "207-807-6731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WHITFORD DR",
"city": "DURHAM",
"state": "NC",
"postal_code": "277089982",
"telephone_number": "207-807-6731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIESEL",
"first_name": "TARA",
"middle_name": "LYNN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-19",
"last_updated": "2021-12-19",
"certification_date": "2021-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.