Provider Demographics
NPI:1972797595
Name:BIELEFELD, TIMOTHY JOHN
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:BIELEFELD
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 1:1185 NW 185TH AVE . STE102
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6209
Mailing Address - Country:US
Mailing Address - Phone:503-216-9760
Mailing Address - Fax:503-216-9765
Practice Address - Street 1:1185 NW 185TH AVE .
Practice Address - Street 2:STE 102
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-6209
Practice Address - Country:US
Practice Address - Phone:503-216-9760
Practice Address - Fax:503-216-9765
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR982232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist