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NPI Code Detail

MEDICARE: TIFFANY MATT

MEDICARE: TIFFANY MATT
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
1224Z00000XOccupational Therapy Assistant32374FL

General Provider Information

NPI Number : 1982187878
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY MATT
Provider Business Mailing Address
First Line : 1625 BEL AIRE DR
Second Line :
City : CRESTVIEW
State : FL
Zip : 32536-3242
Country : US
Telephone Number : 563-271-1839
Fax Number :
Provider Business Practice Location Address
First Line : 114 3RD ST SE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5401
Country : US
Telephone Number : 850-243-6134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2018
Last Update Date : 09/07/2018

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Directions to “ TIFFANY MATT ” Practice Location

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