Provider Demographics
NPI:1073083143
Name:SHEW, TIFFANY (COTA/L)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SHEW
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 1:240 SPRING HILL LN
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-8804
Mailing Address - Country:US
Mailing Address - Phone:301-785-3644
Mailing Address - Fax:
Practice Address - Street 1:11201 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1201
Practice Address - Country:US
Practice Address - Phone:301-785-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01894224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant