Healthcare Provider Details

I. General information

NPI: 1144356320
Provider Name (Legal Business Name): SALLY ELAINE THIMM OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 COMMERCIAL CT #100
VENICE FL
34292-1642
US

IV. Provider business mailing address

5865 HARRISON RD
VENICE FL
34293-6835
US

V. Phone/Fax

Practice location:
  • Phone: 941-228-3562
  • Fax: 941-492-2020
Mailing address:
  • Phone: 941-228-3562
  • Fax: 941-492-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT4376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: