Provider Demographics
NPI:1144356320
Name:THIMM, SALLY ELAINE (OTR)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ELAINE
Last Name:THIMM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-6835
Mailing Address - Country:US
Mailing Address - Phone:941-228-3562
Mailing Address - Fax:941-492-2020
Practice Address - Street 1:425 COMMERCIAL CT
Practice Address - Street 2:#100
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1642
Practice Address - Country:US
Practice Address - Phone:941-228-3562
Practice Address - Fax:941-492-2020
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4376225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6809AMedicare UPIN