Provider Demographics
NPI:1427025048
Name:TARRY, TIFFANY RENEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RENEE
Last Name:TARRY
Suffix:
Gender:F
Credentials:OTR
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 201
Mailing Address - Street 2:4356 2ND ST
Mailing Address - City:LUNA PIER
Mailing Address - State:MI
Mailing Address - Zip Code:48157-0201
Mailing Address - Country:US
Mailing Address - Phone:734-848-4826
Mailing Address - Fax:
Practice Address - Street 1:1422 N MONROE STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-243-0300
Practice Address - Fax:734-243-3066
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist