Provider Demographics
NPI:1205152303
Name:MCKAIG, TIMOTHY NEIL
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:NEIL
Last Name:MCKAIG
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 1:687 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5506
Mailing Address - Country:US
Mailing Address - Phone:239-404-3322
Mailing Address - Fax:
Practice Address - Street 1:687 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5506
Practice Address - Country:US
Practice Address - Phone:239-404-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101220235Z00000X
FLSA2806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist