Provider Demographics
NPI:1760899793
Name:WYNDHAM, TIFFANY (MT-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WYNDHAM
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2551
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2551
Mailing Address - Country:US
Mailing Address - Phone:760-707-3337
Mailing Address - Fax:
Practice Address - Street 1:1312 WARBLER DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7756
Practice Address - Country:US
Practice Address - Phone:760-707-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
08533OtherCBMT (CERTIFICATION BOARD FOR MUSIC THERAPISTS) NUMBER