MEDICARE: MR. TIMOTHY O. OPEEWE 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
1	225X00000X	Occupational Therapist	02711	MD

General Provider Information

NPI Number	:	1578782835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY O. OPEEWE OTR

Provider Business Mailing Address
First Line	:	3506 STONEYBROOK RD
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-4226
Country	:	US
Telephone Number	:	410-521-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	14502 GREENVIEW DR
Second Line	:	SUITE 406
City	:	LAUREL
State	:	MD
Zip	:	20708-3287
Country	:	US
Telephone Number	:	186-656-6531
Fax Number	:	186-656-6531

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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