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General NPI Number Information
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NPI Number | 1962584250
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Entity Type | Individual
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Provider Name | TIFFANY WERNER OTR
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 39 N 25TH ST E
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City | SUPERIOR
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State | WI
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Zip | 54880-5269
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Country | US
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Telephone | 763-689-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 MUNGER SHAW RD
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City | SAGINAW
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State | MN
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Zip | 55779-9523
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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 | 102008
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3072
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License Number State | WI
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