Healthcare Provider Details

I. General information

NPI: 1790818391
Provider Name (Legal Business Name): TIFFANY ELIZABETH HARMON OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ELIZABETH CLIFTON OTR L

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 6F
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

1044 LOUISVILLE AVE
SAINT LOUIS MO
63139-3308
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1669
  • Fax: 314-627-7219
Mailing address:
  • Phone: 314-644-3493
  • Fax: 618-257-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056006785
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2002014414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: