Provider Demographics
NPI:1497219448
Name:MULLEN, TIFFANI ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:ELIZABETH
Last Name:MULLEN
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 1:626 S BURNSIDE AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3917
Mailing Address - Country:US
Mailing Address - Phone:323-206-7278
Mailing Address - Fax:
Practice Address - Street 1:230 E ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1426
Practice Address - Country:US
Practice Address - Phone:213-748-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist