Provider Demographics
NPI:1023883063
Name:KERRIGAN, TIMOTHY JAMES JAMES-LEE
Entity type:Individual
Prefix:
First Name:TIMOTHY JAMES
Middle Name:JAMES-LEE
Last Name:KERRIGAN
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 1:2157 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1511
Mailing Address - Country:US
Mailing Address - Phone:419-320-2905
Mailing Address - Fax:
Practice Address - Street 1:2157 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1511
Practice Address - Country:US
Practice Address - Phone:419-320-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant