Provider Demographics
NPI:1790592533
Name:LANDMAN, TIMOTHIE KATHRYN-LARIE
Entity type:Individual
Prefix:
First Name:TIMOTHIE
Middle Name:KATHRYN-LARIE
Last Name:LANDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 HENKLE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1919
Mailing Address - Country:US
Mailing Address - Phone:740-239-1697
Mailing Address - Fax:
Practice Address - Street 1:1400 US HIGHWAY 22 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-8604
Practice Address - Country:US
Practice Address - Phone:740-335-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005598175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist