Provider Demographics
NPI:1710574264
Name:CUTLIP, TIM
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:CUTLIP
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 1:23627 STATE ROUTE 772
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9269
Mailing Address - Country:US
Mailing Address - Phone:740-941-1925
Mailing Address - Fax:
Practice Address - Street 1:23627 STATE ROUTE 772
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9269
Practice Address - Country:US
Practice Address - Phone:740-941-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6601556374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide