Provider Demographics
NPI:1295221828
Name:ANDREWS, TIMOTHY WILLIAM (ATC, LAT, NREMT-B)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:ATC, LAT, NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6936
Mailing Address - Country:US
Mailing Address - Phone:207-491-0277
Mailing Address - Fax:
Practice Address - Street 1:230 MIDDLE ST.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-0493
Practice Address - Country:US
Practice Address - Phone:207-491-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000260892255A2300X
E3186338146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer