Provider Demographics
NPI:1225255656
Name:KENNY, TIFFANY DAWN (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:DAWN
Last Name:KENNY
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-551-4948
Mailing Address - Fax:
Practice Address - Street 1:5281 N 99TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-3199
Practice Address - Country:US
Practice Address - Phone:623-889-0411
Practice Address - Fax:623-889-0410
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ326755Medicaid