Provider Demographics
NPI:1184362592
Name:NUGENT, TIMOTHY H (MAED, COMS)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:H
Last Name:NUGENT
Suffix:
Gender:M
Credentials:MAED, COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1428
Mailing Address - Country:US
Mailing Address - Phone:812-727-6188
Mailing Address - Fax:
Practice Address - Street 1:528 ELM ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1428
Practice Address - Country:US
Practice Address - Phone:812-727-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7148225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
7148OtherACVREP