Provider Demographics
NPI:1235563156
Name:SHIRLEY, TIMOTHY SEAN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SEAN
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CAPRI DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2233
Mailing Address - Country:US
Mailing Address - Phone:386-405-6586
Mailing Address - Fax:
Practice Address - Street 1:109 CAPRI DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2233
Practice Address - Country:US
Practice Address - Phone:386-405-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12716224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant