Provider Demographics
NPI:1043443021
Name:HERLIHY, TIMOTHY GORDON (OT/L)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GORDON
Last Name:HERLIHY
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 HAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1239
Mailing Address - Country:US
Mailing Address - Phone:704-281-8813
Mailing Address - Fax:704-598-7709
Practice Address - Street 1:3514 HAYDEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1239
Practice Address - Country:US
Practice Address - Phone:704-281-8813
Practice Address - Fax:704-598-7709
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist