MEDICARE: TIMOTHY R CHRISTOPHERSON

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
1	237600000X	Audiologist-Hearing Aid Fitter		MN
2	237700000X	Hearing Instrument Specialist	2054	MN

General Provider Information

NPI Number	:	1447290457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R CHRISTOPHERSON

Provider Business Mailing Address
First Line	:	8800 SE SUNNYSIDE RD STE 300N
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-5703
Country	:	US
Telephone Number	:	281-286-2999
Fax Number	:	512-607-4893

Provider Business Practice Location Address
First Line	:	7738 OLSON MEMORIAL HWY
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55427-4708
Country	:	US
Telephone Number	:	763-545-8193
Fax Number	:	763-545-8385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	02/15/2018

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