Individual
LISA TIMRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
760 NORTH DR, MELBOURNE, FL 32934-9216
(321) 254-4254
Mailing address
4828 SQUIRES DR, TITUSVILLE, FL 32796-1050
(708) 638-8603
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
13707
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13707
—
FL
Enumeration date
07/28/2015
Last updated
11/02/2015
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