Provider Demographics
NPI:1750354429
Name:CARVER, TIMOTHY ALEXANDER (ATC, AT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALEXANDER
Last Name:CARVER
Suffix:
Gender:M
Credentials:ATC, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-3001
Mailing Address - Country:US
Mailing Address - Phone:440-986-2257
Mailing Address - Fax:
Practice Address - Street 1:200 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1051
Practice Address - Country:US
Practice Address - Phone:440-775-8589
Practice Address - Fax:440-775-5262
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-2902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer