MEDICARE: MRS. TIFFANIE RADER

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	224Z00000X	Occupational Therapy Assistant
2	224Z00000X	Occupational Therapy Assistant	02654	OH

General Provider Information

NPI Number	:	1194121780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANIE RADER

Provider Business Mailing Address
First Line	:	10411 T.R. 114
Second Line	:
City	:	VAN BUREN
State	:	OH
Zip	:	45889
Country	:	US
Telephone Number	:	419-957-7973
Fax Number	:

Provider Business Practice Location Address
First Line	:	10411 T.R. 114
Second Line	:
City	:	VAN BUREN
State	:	OH
Zip	:	45889
Country	:	US
Telephone Number	:	419-957-7973
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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