Active NPI
Sean Lally
- Prevention Professional
- Wooster, OH
National Provider Identifier
1972158012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 1619070
- Practice address
- 104 Spink St
Wooster, OH 44691-3652 - Phone
- (330) 264-8498
- Fax
- (330) 264-3777
- NPI assigned
- Aug 6, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 1619070 | OH | Primary |
Addresses
Primary practice location
104 Spink St
Wooster, OH 44691-3652
Mailing address
104 Spink St
Wooster, OH 44691-3652
Phone (330) 264-8498
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 |
|---|---|---|---|
| 1619070 | OH | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1972158012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 SPINK ST",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446913652",
"telephone_number": "330-264-8498",
"fax_number": "330-264-3777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 SPINK ST",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446913652",
"telephone_number": "330-264-8498",
"fax_number": "330-264-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LALLY",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-06",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "OH",
"license": "1619070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wooster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.