Provider Demographics
NPI:1508195207
Name:MARCUM, TIFFANY ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ROSE
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1833 SUNDOWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-4315
Mailing Address - Country:US
Mailing Address - Phone:850-313-9243
Mailing Address - Fax:
Practice Address - Street 1:3387 GULF BREEZE PARKWAY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563
Practice Address - Country:US
Practice Address - Phone:850-530-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15394OtherMANAGED CARE AND MEDICARE PART B