Provider Demographics
NPI:1912769787
Name:HUNT, TIMOTHY MARLOW (ABC PEDORTHIST 1070)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARLOW
Last Name:HUNT
Suffix:
Gender:M
Credentials:ABC PEDORTHIST 1070
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 SMOKING OAKS
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-3465
Mailing Address - Country:US
Mailing Address - Phone:405-633-3217
Mailing Address - Fax:
Practice Address - Street 1:11990 N HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-9411
Practice Address - Country:US
Practice Address - Phone:405-633-3217
Practice Address - Fax:405-683-6027
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist