Provider Demographics
NPI:1043664030
Name:ROMASANTA LEE, TIFFANY (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:ROMASANTA LEE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC
Mailing Address - Street 1:618 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2818
Mailing Address - Country:US
Mailing Address - Phone:580-613-0020
Mailing Address - Fax:
Practice Address - Street 1:618 N 5TH ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2818
Practice Address - Country:US
Practice Address - Phone:580-613-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10769225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist