Provider Demographics
NPI:1770720237
Name:RICHARDS, TIMOTHY JR
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:RICHARDS
Suffix:JR
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 1:1330 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7850
Mailing Address - Country:US
Mailing Address - Phone:252-758-7048
Mailing Address - Fax:252-215-5614
Practice Address - Street 1:1330 E ARLINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7850
Practice Address - Country:US
Practice Address - Phone:252-758-7048
Practice Address - Fax:252-215-5614
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4542225X00000X
FLOT11964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4542OtherNORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY