Provider Demographics
NPI:1497886733
Name:TIMMER, JENNIFER ANN (ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:TIMMER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11537 N BAILEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BAILEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61007-9721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11537 N BAILEYVILLE RD
Practice Address - Street 2:
Practice Address - City:BAILEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:61007-9721
Practice Address - Country:US
Practice Address - Phone:815-938-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer