Provider Demographics
NPI:1750433512
Name:MAGER, TIMOTHY RUSSELL (OTRL)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RUSSELL
Last Name:MAGER
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 CONSTITUTION AVENUE
Mailing Address - Street 2:REHABILITATION TODAY SERVICES PLLC
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-2808
Mailing Address - Fax:716-372-2902
Practice Address - Street 1:2416 CONSTITUTION AVENUE
Practice Address - Street 2:REHABILITATION TODAY SERVICES PLLC
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-2808
Practice Address - Fax:716-372-2902
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036531225X00000X
PAOC000887L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist