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General NPI Number Information
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NPI Number | 1417708256
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Entity Type | Individual
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Provider Name | TIFFANI RAE HOTWAGNER BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1639 N ALPINE RD
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City | ROCKFORD
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State | IL
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Zip | 61107-1449
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Country | US
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Telephone | 815-484-3143
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Fax |
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Provider Business Mailing Address
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Address Line | 6614 LANTERNE DR
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City | LOVES PARK
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State | IL
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Zip | 61111-3526
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Country | US
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Telephone | 630-701-5249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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