MEDICARE: TIFFANI SUHM

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

General Provider Information

NPI Number	:	1538833439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI SUHM

Provider Business Mailing Address
First Line	:	9 EDWARD DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-9789
Country	:	US
Telephone Number	:	845-707-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 N BALLSTON AVE
Second Line	:
City	:	SCOTIA
State	:	NY
Zip	:	12302-2427
Country	:	US
Telephone Number	:	518-370-4700
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “ TIFFANI SUHM ” Practice Location

Language	Start Address	Practice Location

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