Provider Demographics
NPI:1871762310
Name:TIMBERS, EVONDA (CMT)
Entity type:Individual
Prefix:
First Name:EVONDA
Middle Name:
Last Name:TIMBERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MANYMIND AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1622
Mailing Address - Country:US
Mailing Address - Phone:908-902-1579
Mailing Address - Fax:
Practice Address - Street 1:11 MANYMIND AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1622
Practice Address - Country:US
Practice Address - Phone:908-902-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00045400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist