Provider Demographics
NPI:1467978528
Name:MPOFU, TIFFANY DIMERA (CVRT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DIMERA
Last Name:MPOFU
Suffix:
Gender:F
Credentials:CVRT
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:DIMERA
Other - Last Name:SPIVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CVRT
Mailing Address - Street 1:2953 SQUIRREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5502
Mailing Address - Country:US
Mailing Address - Phone:269-447-9568
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-725-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI70472255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind