Provider Demographics
NPI:1659547222
Name:NG, TIFFANIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TIFFANIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 EL CAMINO REAL
Mailing Address - Street 2:UNIT 118
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1203
Mailing Address - Country:US
Mailing Address - Phone:415-793-6483
Mailing Address - Fax:
Practice Address - Street 1:225 37TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4324
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9974225XP0200X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No101Y00000XBehavioral Health & Social Service ProvidersCounselor