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General NPI Number Information
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NPI Number | 1881809317
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Entity Type | Individual
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Provider Name | MR. TIMOTHY HENNESSEY
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23271 VERDUGO DR #B
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1347
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Country | US
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Telephone | 949-707-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 234 6TH ST APT 12
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City | SEAL BEACH
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State | CA
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Zip | 90740-6164
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Country | US
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Telephone | 562-338-5786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 7461
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License Number State | CA
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