Provider Demographics
NPI:1518126150
Name:FOX, TIFFANY LAUREL (OTR)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:LAUREL
Last Name:FOX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:512-417-0164
Mailing Address - Fax:
Practice Address - Street 1:848 W PALMA VISTA DR
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-2144
Practice Address - Country:US
Practice Address - Phone:956-583-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021738201Medicaid
TX1093891053OtherORGANIZATIONAL NPI
TX456838Medicare Oscar/Certification