Provider Demographics
NPI:1114592037
Name:SHOEMAKER, TIFFANY F (OTA/L,CLT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:F
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:OTA/L,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SPYGLASS CT STE 120
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7948
Mailing Address - Country:US
Mailing Address - Phone:321-241-6543
Mailing Address - Fax:321-241-6513
Practice Address - Street 1:7000 SPYGLASS CT STE 120
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7948
Practice Address - Country:US
Practice Address - Phone:321-241-6543
Practice Address - Fax:321-241-6513
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant