Provider Demographics
NPI:1326459330
Name:CROMER, TIFFANY LATASHA MARIE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LATASHA MARIE
Last Name:CROMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LATASHA MARIE
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 CAMI CT APT 503
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-1184
Mailing Address - Country:US
Mailing Address - Phone:859-816-7663
Mailing Address - Fax:
Practice Address - Street 1:64 CAMI CT APT 503
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-1184
Practice Address - Country:US
Practice Address - Phone:859-816-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist