Provider Demographics
NPI:1740304930
Name:KRILEY, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:KRILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ELLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67637-2230
Mailing Address - Country:US
Mailing Address - Phone:785-259-4357
Mailing Address - Fax:
Practice Address - Street 1:600 MONROE ST
Practice Address - Street 2:
Practice Address - City:ELLIS
Practice Address - State:KS
Practice Address - Zip Code:67637-2230
Practice Address - Country:US
Practice Address - Phone:785-259-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer