Provider Demographics
NPI:1124290770
Name:VOTAVA, TIMOTHY V
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:V
Last Name:VOTAVA
Suffix:
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 1:12737 RIVERDALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1253
Mailing Address - Country:US
Mailing Address - Phone:763-421-1688
Mailing Address - Fax:763-421-1788
Practice Address - Street 1:12737 RIVERDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1253
Practice Address - Country:US
Practice Address - Phone:763-421-1688
Practice Address - Fax:763-421-1788
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2512237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist