Provider Demographics
NPI:1801212162
Name:BAUTISTA, TIFFANY (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FRESH PONDS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3017
Mailing Address - Country:US
Mailing Address - Phone:732-484-0285
Mailing Address - Fax:
Practice Address - Street 1:2 DEERPARK DR
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1919
Practice Address - Country:US
Practice Address - Phone:732-274-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00528600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist