Provider Demographics
NPI:1578028387
Name:MAPLE, TIFFANY (LMT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MAPLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 LICKING PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3046
Mailing Address - Country:US
Mailing Address - Phone:859-360-0664
Mailing Address - Fax:
Practice Address - Street 1:419 LICKING PIKE STE B
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071-3046
Practice Address - Country:US
Practice Address - Phone:859-360-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist