Provider Demographics
NPI:1528204880
Name:TIMMES - GRAB, ELLEN MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:MARIE
Last Name:TIMMES - GRAB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 LOUDEN RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5499
Mailing Address - Country:US
Mailing Address - Phone:518-584-1470
Mailing Address - Fax:
Practice Address - Street 1:14 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1019
Practice Address - Country:US
Practice Address - Phone:518-695-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 003817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist