Provider Demographics
NPI:1790818391
Name:CLIFTON, TIFFANY ELIZABETH (OTR L)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ELIZABETH
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR L
Mailing Address - Street 1:1044 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139
Mailing Address - Country:US
Mailing Address - Phone:314-644-3493
Mailing Address - Fax:618-257-6805
Practice Address - Street 1:4550 MEMORIAL DR
Practice Address - Street 2:MEDICAL BUILDING #1 STE 470
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-5249
Practice Address - Fax:618-257-6805
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014414225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist