Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119-008675 | VA |
NPI | 1003426115 |
---|---|
Provider Name | Marta Timmermann |
First Address | Roanoke, VA 24018-6850 |
Second Address | Daleville, VA 24083-3205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |