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General NPI Number Information
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NPI Number | 1508195207
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Entity Type | Individual
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Provider Name | TIFFANY ROSE MARCUM OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 3387 GULF BREEZE PARKWAY
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City | GULF BREEZE
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State | FL
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Zip | 32563
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Country | US
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Telephone | 850-530-8189
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 SUNDOWN DRIVE
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City | NAVARRE
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State | FL
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Zip | 32566-4315
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Country | US
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Telephone | 850-313-9243
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 15394
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License Number State | FL
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