Healthcare Provider Details

I. General information

NPI: 1710898242
Provider Name (Legal Business Name): TIFFANY L THERRIEN MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 E ARBOR AVE
MESA AZ
85206-1681
US

IV. Provider business mailing address

130 N LESUEUR APT 62
MESA AZ
85203-8778
US

V. Phone/Fax

Practice location:
  • Phone: 480-520-1419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-007264
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: