Provider Demographics
NPI:1609918085
Name:TIFFANY, NORMAN (COTA L)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:TIFFANY
Suffix:
Gender:M
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E SHEA BLVD APT 1242
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3284
Mailing Address - Country:US
Mailing Address - Phone:602-400-7536
Mailing Address - Fax:
Practice Address - Street 1:3040 E SHEA BLVD APT 1242
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3284
Practice Address - Country:US
Practice Address - Phone:602-400-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3771224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant