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General NPI Number Information
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NPI Number | 1679679641
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Entity Type | Individual
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Provider Name | TIFFANY BERTH
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 501 PARK AVE
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City | OCONTO
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State | WI
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Zip | 54153-1612
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Country | US
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Telephone | 920-834-6875
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Fax |
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Provider Business Mailing Address
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Address Line | N2059 BONNIE LN
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City | MARINETTE
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State | WI
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Zip | 54143-9469
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Country | US
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Telephone |
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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 | 2754-26
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License Number State |
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