Provider Demographics
NPI:1497011829
Name:SCOTT, TIFFANY LEE (MS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 W DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3628
Mailing Address - Country:US
Mailing Address - Phone:918-615-6492
Mailing Address - Fax:918-609-6002
Practice Address - Street 1:2221 W DETROIT ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3628
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:918-609-6002
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist