Healthcare Provider Details

I. General information

NPI: 1720361942
Provider Name (Legal Business Name): TIFFANY JANE KUHL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY JANE ROBERTSON OTR/L

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 24TH ST
ROCK ISLAND IL
61201-5305
US

IV. Provider business mailing address

1004 FRANKLIN AVE
DAVENPORT IA
52806-7602
US

V. Phone/Fax

Practice location:
  • Phone: 309-788-0458
  • Fax:
Mailing address:
  • Phone: 309-339-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056009481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002168
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: