Provider Demographics
NPI:1093840589
Name:PASSMORE, TIM RJ (EDD, CTRS)
Entity Type:Individual
Prefix:PROF
First Name:TIM
Middle Name:RJ
Last Name:PASSMORE
Suffix:
Gender:M
Credentials:EDD, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2101
Mailing Address - Country:US
Mailing Address - Phone:405-744-1811
Mailing Address - Fax:405-744-6507
Practice Address - Street 1:3124 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-2101
Practice Address - Country:US
Practice Address - Phone:405-744-1811
Practice Address - Fax:405-744-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No174400000XOther Service ProvidersSpecialist