Provider Demographics
NPI:1194262337
Name:DELANEY, TYLER (ATC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:DELANEY
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 1:133A RAMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-7765
Mailing Address - Country:US
Mailing Address - Phone:207-577-1065
Mailing Address - Fax:
Practice Address - Street 1:41 MORRILL AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1427
Practice Address - Country:US
Practice Address - Phone:207-222-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer