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NPI Code Detail

MEDICARE: MR. TIMOTHY R LUPIEN OTR

MEDICARE:  MR. TIMOTHY R LUPIEN  OTR
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
1225X00000XOccupational TherapistOT000594GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GRP7271OTHERGAMEDICARE LEGACY/PTAN

General Provider Information

NPI Number : 1386707271
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY R LUPIEN OTR
Provider Business Mailing Address
First Line : 5041 DALLAS HWY BLDG 1C
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-6459
Country : US
Telephone Number : 770-425-2151
Fax Number : 770-425-5982
Provider Business Practice Location Address
First Line : 5041 DALLAS HWY BLDG 1C
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-6459
Country : US
Telephone Number : 770-425-2151
Fax Number : 770-425-5982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 12/10/2007

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Directions to “ MR. TIMOTHY R LUPIEN OTR” Practice Location

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