Provider Demographics
NPI:1669904348
Name:TIMMS, SHELBY (BA, LMT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:TIMMS
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 NW QUINN CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703
Mailing Address - Country:US
Mailing Address - Phone:541-610-8243
Mailing Address - Fax:
Practice Address - Street 1:265 NW FRANKLIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2802
Practice Address - Country:US
Practice Address - Phone:541-610-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist