Healthcare Provider Details

I. General information

NPI: 1649953035
Provider Name (Legal Business Name): TIFFANI BRICE GARSKOF OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANI BRICE FISHER OTD, OTR/L

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST APT 521
MOUNT PROSPECT IL
60056-2394
US

IV. Provider business mailing address

10 N MAIN ST
MOUNT PROSPECT IL
60056-2406
US

V. Phone/Fax

Practice location:
  • Phone: 630-636-1610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5839
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056015875
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: