Healthcare Provider Details

I. General information

NPI: 1659065712
Provider Name (Legal Business Name): WILLIAM MCKAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WAMPANOAG TRL STE 302
RIVERSIDE RI
02915-2217
US

IV. Provider business mailing address

222 JEFFERSON BLVD STE 4
WARWICK RI
02888-3847
US

V. Phone/Fax

Practice location:
  • Phone: 401-423-4433
  • Fax:
Mailing address:
  • Phone: 401-423-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT02598
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: