Provider Demographics
NPI:1770213381
Name:MOTLEY, TIFFANY NICOLE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 S LEGARE CT APT 110
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5167
Mailing Address - Country:US
Mailing Address - Phone:513-516-2496
Mailing Address - Fax:
Practice Address - Street 1:8218 S LEGARE CT APT 110
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5167
Practice Address - Country:US
Practice Address - Phone:513-516-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401812381215251E00000X, 374U00000X, 253Z00000X, 372600000X, 3747A0650X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider