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General NPI Number Information
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NPI Number | 1801519996
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Entity Type | Individual
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Provider Name | TIFFANY COURTNEY
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 2395 MINTON RD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-6607
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Country | US
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Telephone | 321-220-0295
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Fax |
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Provider Business Mailing Address
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Address Line | 2397 COGAN DR SE
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City | PALM BAY
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State | FL
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Zip | 32909-8478
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Country | US
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Telephone | 321-543-1151
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 15950
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License Number State | FL
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