Provider Demographics
NPI:1649326968
Name:WAKEFIELD, TIMOTHY JON (ATC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JON
Last Name:WAKEFIELD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 THANKFUL LN
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2616
Mailing Address - Country:US
Mailing Address - Phone:508-420-0557
Mailing Address - Fax:
Practice Address - Street 1:33 HIGHFIELD DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2303
Practice Address - Country:US
Practice Address - Phone:508-548-7491
Practice Address - Fax:508-457-4907
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer