Provider Demographics
NPI:1275423832
Name:TYMOS, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TYMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W PAPERMILL RUN APT 305
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-5506
Mailing Address - Country:US
Mailing Address - Phone:920-460-9600
Mailing Address - Fax:
Practice Address - Street 1:N496 MILKY WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3993
Practice Address - Country:US
Practice Address - Phone:920-738-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8466-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist