Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0010-10530 | NC |
N | 224Z00000X | Occupational Therapy Assistant | 5202007565 | MI |
NPI | 1003444654 |
---|---|
Provider Name | Mr. Trenton Peter Timmer |
First Address | Charlotte, NC 28203-6428 |
Second Address | Hickory, NC 28602-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2020 |
Last Update Date | 03/05/2021 |