Provider Demographics
NPI:1194003970
Name:JORDAN, TIFFANIE N (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:N
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4998
Mailing Address - Country:US
Mailing Address - Phone:940-597-4027
Mailing Address - Fax:
Practice Address - Street 1:405 CASTLE ST
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4998
Practice Address - Country:US
Practice Address - Phone:940-597-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist