Provider Demographics
NPI:1730441452
Name:FLYNN, TIMOTHY (OT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5404
Mailing Address - Country:US
Mailing Address - Phone:908-240-1421
Mailing Address - Fax:
Practice Address - Street 1:200 BERWICK RD
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17859
Practice Address - Country:US
Practice Address - Phone:570-683-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist