MEDICARE: TIFFANY MAE OLIPHANT

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1932960622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MAE OLIPHANT

Provider Business Mailing Address
First Line	:	4880 S MAIN ST STE 1&2
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-4474
Country	:	US
Telephone Number	:	234-294-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	4880 S MAIN ST STE 1&2
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-4474
Country	:	US
Telephone Number	:	234-294-0781
Fax Number	:

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

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	01/19/2024

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Directions to “ TIFFANY MAE OLIPHANT ” Practice Location

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