Provider Demographics
NPI:1306383880
Name:JIMOH, TERRILL
Entity Type:Individual
Prefix:
First Name:TERRILL
Middle Name:
Last Name:JIMOH
Suffix:
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 1:2900 S SERVICE RD APT 1515
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5585
Mailing Address - Country:US
Mailing Address - Phone:405-589-9207
Mailing Address - Fax:
Practice Address - Street 1:2900 S SERVICE RD APT 1515
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5585
Practice Address - Country:US
Practice Address - Phone:405-589-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer