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NPI Code Detail

MEDICARE: MRS. TIFFANY D GOLD OTR, MHA

MEDICARE: MRS. TIFFANY D GOLD OTR, MHA
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
1225X00000XOccupational Therapist111355TX

General Provider Information

NPI Number : 1306040340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TIFFANY D GOLD OTR, MHA
Provider Business Mailing Address
First Line : 13119 WILLOWTHORN LN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-4855
Country : US
Telephone Number : 210-696-0004
Fax Number :
Provider Business Practice Location Address
First Line : 855 E BASSE RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78209-1890
Country : US
Telephone Number : 210-824-6280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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