Provider Demographics
NPI:1326218488
Name:HURLBUT, TIFFANY (SLP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HURLBUT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8525
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-0525
Mailing Address - Country:US
Mailing Address - Phone:330-505-1606
Mailing Address - Fax:330-505-1606
Practice Address - Street 1:309 RHODES RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-0525
Practice Address - Country:US
Practice Address - Phone:330-505-1606
Practice Address - Fax:330-505-1606
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09146429222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist