Provider Demographics
NPI:1235560046
Name:OGLESBY, TIFFANY-RAE LANI
Entity Type:Individual
Prefix:
First Name:TIFFANY-RAE
Middle Name:LANI
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 COUNTY ROAD 148
Mailing Address - Street 2:
Mailing Address - City:NEW BROCKTON
Mailing Address - State:AL
Mailing Address - Zip Code:36351-8106
Mailing Address - Country:US
Mailing Address - Phone:334-406-0066
Mailing Address - Fax:
Practice Address - Street 1:795 COUNTY ROAD 148
Practice Address - Street 2:
Practice Address - City:NEW BROCKTON
Practice Address - State:AL
Practice Address - Zip Code:36351-8106
Practice Address - Country:US
Practice Address - Phone:334-406-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other