MEDICARE: TIFFANY NICOLE ROE

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	103K00000X	Behavior Analyst		OK

General Provider Information

NPI Number	:	1275168221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY NICOLE ROE

Provider Business Mailing Address
First Line	:	3637 ROLLING LANE CIR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-1219
Country	:	US
Telephone Number	:	928-846-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 ROLLING LANE CIR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-1219
Country	:	US
Telephone Number	:	928-846-1833
Fax Number	:

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

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	11/20/2023

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Directions to “ TIFFANY NICOLE ROE ” Practice Location

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