Provider Demographics
NPI:1144703356
Name:TASKER, TIMOTHY NELSON
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NELSON
Last Name:TASKER
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 1:2100 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-2921
Mailing Address - Country:US
Mailing Address - Phone:765-210-9738
Mailing Address - Fax:
Practice Address - Street 1:970 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5488
Practice Address - Country:US
Practice Address - Phone:765-210-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214121224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214121OtherINSURANCE
TX214121Medicaid