Provider Demographics
NPI:1184814741
Name:WALLMAN, TIFFANY ETTA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ETTA
Last Name:WALLMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2039
Mailing Address - Country:US
Mailing Address - Phone:402-223-7309
Mailing Address - Fax:402-223-7349
Practice Address - Street 1:1110 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2039
Practice Address - Country:US
Practice Address - Phone:402-223-7309
Practice Address - Fax:402-223-7349
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist