MEDICARE: MS. CORLIA TIMMERMAN OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT11798	FL

General Provider Information

NPI Number	:	1336186295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORLIA TIMMERMAN OT

Provider Business Mailing Address
First Line	:	10461 BOYNTON PLACE CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-2628
Country	:	US
Telephone Number	:	561-499-3041
Fax Number	:	561-499-3042

Provider Business Practice Location Address
First Line	:	6200 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3501
Country	:	US
Telephone Number	:	561-499-3041
Fax Number	:	561-499-3042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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