Provider Demographics
NPI:1437691821
Name:LEE, TIFFANY (MA, OTR, BCB-PMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, OTR, BCB-PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 HUNTER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5255
Mailing Address - Country:US
Mailing Address - Phone:512-557-6310
Mailing Address - Fax:512-805-0046
Practice Address - Street 1:2406 HUNTER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5255
Practice Address - Country:US
Practice Address - Phone:512-557-6310
Practice Address - Fax:512-396-8006
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist