Provider Demographics
NPI:1750466025
Name:FEEHAN, TIMOTHY J SR
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:FEEHAN
Suffix:SR
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 1:484 COUNTY ROAD 134
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9633
Mailing Address - Country:US
Mailing Address - Phone:419-333-1333
Mailing Address - Fax:419-333-3123
Practice Address - Street 1:484 COUNTY ROAD 134
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9633
Practice Address - Country:US
Practice Address - Phone:419-333-1333
Practice Address - Fax:419-333-3123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200615102310171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632799Medicaid