Provider Demographics
NPI:1942896444
Name:CLOUSER, TIMOTHY L
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:CLOUSER
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 1:7350 MAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7704
Mailing Address - Country:US
Mailing Address - Phone:937-403-4865
Mailing Address - Fax:
Practice Address - Street 1:7350 MAD RIVER RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7704
Practice Address - Country:US
Practice Address - Phone:937-403-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker