Provider Demographics
NPI:1043791593
Name:HARRIS, TIFFANY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 NW 31ST AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2570
Mailing Address - Country:US
Mailing Address - Phone:754-244-4487
Mailing Address - Fax:
Practice Address - Street 1:6931 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4406
Practice Address - Country:US
Practice Address - Phone:954-583-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12191224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant