Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1962628768 |
---|---|
Provider Name | Mr. Timothy John Mulvihill JR. |
First Address | Edgewater, MD 21037-4814 |
Second Address | Edgewater, MD 21037-4814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 17/07/2007 |