Individual
TIMOTHY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT, OTR/L
Contact information
Practice address
81337 AVENIDA ROMERO, INDIO, CA 92201
(760) 485-7656
Mailing address
81337 AVENIDA ROMERO, INDIO, CA 92201
(760) 485-7656
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
14812
CA
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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