Healthcare Provider Details

I. General information

NPI: 1215851944
Provider Name (Legal Business Name): TIFFANY R AUCOIN LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 N OLD CASTLE RD
NIXA MO
65714-8507
US

IV. Provider business mailing address

4637 S BOTHWELL CT
SPRINGFIELD MO
65804-7510
US

V. Phone/Fax

Practice location:
  • Phone: 417-217-7099
  • Fax:
Mailing address:
  • Phone: 504-266-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024000108
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: