Provider Demographics
NPI:1063453009
Name:SPEAR, TIMOTHY R (ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:SPEAR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSSIPEE TRL E
Mailing Address - Street 2:SUITE 1151
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6464
Mailing Address - Country:US
Mailing Address - Phone:207-642-5325
Mailing Address - Fax:207-642-5395
Practice Address - Street 1:111 OSSIPEE TRL E
Practice Address - Street 2:SUITE 1151
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6464
Practice Address - Country:US
Practice Address - Phone:207-642-5325
Practice Address - Fax:207-642-5395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT1632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer