MEDICARE: MR. TIMOTHY S HAY ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1569	MA

General Provider Information

NPI Number	:	1114980216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY S HAY ATC

Provider Business Mailing Address
First Line	:	25 BRIARWOOD LN
Second Line	:	APT 1
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2504
Country	:	US
Telephone Number	:	508-963-7486
Fax Number	:	508-767-7032

Provider Business Practice Location Address
First Line	:	500 SALISBURY ST
Second Line	:	ASSUMPTION COLLEGE
City	:	WORCESTER
State	:	MA
Zip	:	01609-1265
Country	:	US
Telephone Number	:	508-767-7238
Fax Number	:	508-767-7032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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