MEDICARE: TIFFANY WEST OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5649759-4201	UT

General Provider Information

NPI Number	:	1932521663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY WEST OT

Provider Business Mailing Address
First Line	:	3326 W 5820 S
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-7130
Country	:	US
Telephone Number	:	801-706-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3497 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2537
Country	:	US
Telephone Number	:	801-417-5017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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Directions to “ TIFFANY WEST OT” Practice Location

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