Provider Demographics
NPI:1124372800
Name:HART, TIMBER (LAC)
Entity Type:Individual
Prefix:
First Name:TIMBER
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9964 WAGNER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-7804
Mailing Address - Country:US
Mailing Address - Phone:541-535-3202
Mailing Address - Fax:541-535-6573
Practice Address - Street 1:9964 WAGNER CREEK RD
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-7804
Practice Address - Country:US
Practice Address - Phone:541-535-3202
Practice Address - Fax:541-535-6573
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist