Provider Demographics
NPI:1194252882
Name:TIMLIN, JEFFREY (DAT,MS,LAT,ATC,PES)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:TIMLIN
Suffix:
Gender:M
Credentials:DAT,MS,LAT,ATC,PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 11456
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0017
Mailing Address - Country:US
Mailing Address - Phone:570-592-5173
Mailing Address - Fax:
Practice Address - Street 1:KADENA AIR FORCE BASE
Practice Address - Street 2:
Practice Address - City:KADENA
Practice Address - State:OKINAWA
Practice Address - Zip Code:96367
Practice Address - Country:JP
Practice Address - Phone:570-592-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0059022255A2300X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No173000000XOther Service ProvidersLegal Medicine