Provider Demographics
NPI:1003247610
Name:TWYMON, VALERIE (PT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:TWYMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4425
Mailing Address - Country:US
Mailing Address - Phone:443-880-3457
Mailing Address - Fax:
Practice Address - Street 1:115 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4425
Practice Address - Country:US
Practice Address - Phone:443-880-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17795171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor