Healthcare Provider Details

I. General information

NPI: 1669094561
Provider Name (Legal Business Name): TIMOTHY G DUNNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 WEBSTER ST
OMAHA NE
68132-2020
US

IV. Provider business mailing address

5816 WEBSTER ST
OMAHA NE
68132-2020
US

V. Phone/Fax

Practice location:
  • Phone: 347-458-2611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2319
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: