Provider Demographics
NPI:1487192654
Name:BEIHL, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BEIHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SUNFLOWER LN SW
Mailing Address - Street 2:APARTMENT 38-304
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8333
Mailing Address - Country:US
Mailing Address - Phone:740-359-8769
Mailing Address - Fax:
Practice Address - Street 1:11506 NICHOLAS ST
Practice Address - Street 2:STE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4407
Practice Address - Country:US
Practice Address - Phone:402-505-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004881174400000X
WAOT60722954225X00000X
NC10256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist