Healthcare Provider Details

I. General information

NPI: 1679237705
Provider Name (Legal Business Name): TIFFANY MICHELLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 PROSPERITY PARK DR STE 300
CHARLOTTE NC
28269-1106
US

IV. Provider business mailing address

101 S TRYON ST STE 2700-126
CHARLOTTE NC
28280-0002
US

V. Phone/Fax

Practice location:
  • Phone: 800-701-0498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18638
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-198547
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: