Provider Demographics
NPI:1609003847
Name:BLACKWELL, TIFFANY V (NMT-FELLOW)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:V
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:NMT-FELLOW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3816
Mailing Address - Country:US
Mailing Address - Phone:913-383-8465
Mailing Address - Fax:
Practice Address - Street 1:6800 W 80TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3816
Practice Address - Country:US
Practice Address - Phone:913-383-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist