Provider Demographics
NPI:1336186295
Name:TIMMERMAN, CORLIA (OT)
Entity Type:Individual
Prefix:MS
First Name:CORLIA
Middle Name:
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10461 BOYNTON PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2628
Mailing Address - Country:US
Mailing Address - Phone:561-499-3041
Mailing Address - Fax:561-499-3042
Practice Address - Street 1:6200 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3501
Practice Address - Country:US
Practice Address - Phone:561-499-3041
Practice Address - Fax:561-499-3042
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6738AMedicare ID - Type Unspecified