MEDICARE: TIFFANY S NORTON OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056012058	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	853956157	OTHER	IL	PRIVATE INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013432111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY S NORTON OT

Provider Business Mailing Address
First Line	:	1901 S CALUMET AVE UNIT 2011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-6024
Country	:	US
Telephone Number	:	810-962-6582
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 S CALUMET AVE UNIT 2011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-6024
Country	:	US
Telephone Number	:	810-962-6582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	12/07/2020

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