Individual
TIMOTHY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6500 MACCORKLE AVE, SAINT ALBANS, WV 25177-2326
(304) 768-0002
Mailing address
6500 MACCORKLE AVE, SAINT ALBANS, WV 25177-2326
(304) 768-0002
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1274
WI
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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