Provider Demographics
NPI:1346778883
Name:SMITH, TIFFANY S (COTA/L)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 COLE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24589-2654
Mailing Address - Country:US
Mailing Address - Phone:434-265-4035
Mailing Address - Fax:
Practice Address - Street 1:84 JOHNSON ESTATE RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9289
Practice Address - Country:US
Practice Address - Phone:919-359-9073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000968224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant