Healthcare Provider Details

I. General information

NPI: 1427634724
Provider Name (Legal Business Name): TIFFANY NANA HENZE MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 110
LA MESA CA
91942-3012
US

IV. Provider business mailing address

11736 CARMEL CREEK RD APT 201
SAN DIEGO CA
92130-6616
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-5200
  • Fax:
Mailing address:
  • Phone: 773-459-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22168
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: