Provider Demographics
NPI:1659046134
Name:WOOLLARD, TIMOTHY
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:WOOLLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MCKINLEY AVE. BOX 337
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719
Mailing Address - Country:US
Mailing Address - Phone:740-359-4899
Mailing Address - Fax:
Practice Address - Street 1:68353 BANNOCK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9736
Practice Address - Country:US
Practice Address - Phone:740-359-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator