Provider Demographics
NPI:1740385954
Name:BEITZ, TIFFANY PEARIGEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:PEARIGEN
Last Name:BEITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:LYNN
Other - Last Name:PEARIGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1803 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2813
Mailing Address - Country:US
Mailing Address - Phone:803-738-8962
Mailing Address - Fax:
Practice Address - Street 1:7601 PARKLANE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6122
Practice Address - Country:US
Practice Address - Phone:803-741-9090
Practice Address - Fax:803-741-1914
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist