Provider Demographics
NPI:1326844846
Name:TIMMERMAN, EMMA BROOKE (MT-BC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:BROOKE
Last Name:TIMMERMAN
Suffix:
Gender:
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7148
Mailing Address - Country:US
Mailing Address - Phone:801-200-3273
Mailing Address - Fax:
Practice Address - Street 1:749 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7148
Practice Address - Country:US
Practice Address - Phone:801-200-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT19338225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist