Healthcare Provider Details

I. General information

NPI: 1073541967
Provider Name (Legal Business Name): CHRISTINE MARIE TIMMERMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 WINSTON AVE
COVINGTON KY
41015
US

IV. Provider business mailing address

4339 WINSTON AVE
COVINGTON KY
41015-1739
US

V. Phone/Fax

Practice location:
  • Phone: 859-835-2573
  • Fax:
Mailing address:
  • Phone: 859-835-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number243233
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: