Provider Demographics
NPI:1700539202
Name:O'CONNOR, TIMOTHY (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 LOGAN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9747
Mailing Address - Country:US
Mailing Address - Phone:724-261-6036
Mailing Address - Fax:
Practice Address - Street 1:555 RIAL LN
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4683
Practice Address - Country:US
Practice Address - Phone:724-787-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst