Provider Demographics
NPI:1831387406
Name:BANISH, TIMOTHY PATRICK SR (COTA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:BANISH
Suffix:SR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1610 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2002
Mailing Address - Country:US
Mailing Address - Phone:513-542-6847
Mailing Address - Fax:
Practice Address - Street 1:8650 GOVERNORS HILL DR
Practice Address - Street 2:SUITE 180
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1372
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:513-683-1500
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA02490224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant