Basic Information
| Provider Information | |||||||||
| NPI: | 1972797595 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIELEFELD | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1185 NW 185TH AVE . STE102 | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970066209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032169760 | ||||||||
| FaxNumber: | 5032169765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 NW 185TH AVE . | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970066209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032169760 | ||||||||
| FaxNumber: | 5032169765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 982232 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.