Healthcare Provider Details

I. General information

NPI: 1316357502
Provider Name (Legal Business Name): TIMOTHY MAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MARSH RD
PELHAM NH
03076-3134
US

IV. Provider business mailing address

16 MARIANNE DR
PLAISTOW NH
03865-3133
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0524
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2490
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: