Provider Demographics
NPI:1740570498
Name:AVERY, TIFFANY G (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:G
Last Name:AVERY
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WORLD CUP WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4950
Mailing Address - Country:US
Mailing Address - Phone:972-712-2669
Mailing Address - Fax:972-712-4514
Practice Address - Street 1:9200 WORLD CUP WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4950
Practice Address - Country:US
Practice Address - Phone:972-712-2669
Practice Address - Fax:972-712-4514
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112125225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand