Provider Demographics
NPI:1235572892
Name:THOMPSON, TIMMOTHY ALLAN II
Entity Type:Individual
Prefix:MR
First Name:TIMMOTHY
Middle Name:ALLAN
Last Name:THOMPSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4741
Mailing Address - Country:US
Mailing Address - Phone:937-668-4389
Mailing Address - Fax:
Practice Address - Street 1:2121 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-4741
Practice Address - Country:US
Practice Address - Phone:937-668-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion