Provider Demographics
NPI:1467655829
Name:STOOTS, TIFFANY R (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:R
Last Name:STOOTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N BARDSTOWN RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7844
Mailing Address - Country:US
Mailing Address - Phone:502-538-2332
Mailing Address - Fax:
Practice Address - Street 1:1123 N BARDSTOWN RD UNIT 4
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7844
Practice Address - Country:US
Practice Address - Phone:502-538-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3725225X00000X
MN104876225X00000X
AL3309225XP0019X
KY173085225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104876OtherLICENSE
KY173085OtherLICENSE