Provider Demographics
NPI:1336509850
Name:TIFFT, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:TIFFT
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 1:5 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7719
Mailing Address - Country:US
Mailing Address - Phone:518-926-8141
Mailing Address - Fax:
Practice Address - Street 1:200 BERWICK RD
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17859-9064
Practice Address - Country:US
Practice Address - Phone:570-683-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist