Provider Demographics
NPI:1154660157
Name:ACQUAFREDDA, TIFFANY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:ACQUAFREDDA
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 1:501 SCENIC RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7618
Mailing Address - Country:US
Mailing Address - Phone:321-302-8254
Mailing Address - Fax:
Practice Address - Street 1:501 SCENIC RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7618
Practice Address - Country:US
Practice Address - Phone:321-302-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11495224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant