Provider Demographics
NPI:1174039879
Name:NELSON, TIFFANY (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WIND RIVER LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-8945
Mailing Address - Country:US
Mailing Address - Phone:208-850-2252
Mailing Address - Fax:
Practice Address - Street 1:1525 WIND RIVER LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-8945
Practice Address - Country:US
Practice Address - Phone:208-850-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer