Provider Demographics
NPI:1851308530
Name:MARCUM, TIMOTHY OWEN (OT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:OWEN
Last Name:MARCUM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380
Mailing Address - Country:US
Mailing Address - Phone:606-663-8244
Mailing Address - Fax:606-663-8284
Practice Address - Street 1:436 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380
Practice Address - Country:US
Practice Address - Phone:606-663-8244
Practice Address - Fax:606-663-8284
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2025225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8800044300Medicaid
KY0917209Medicare ID - Type Unspecified