Provider Demographics
NPI:1801380217
Name:BEAUCHAMP, TIFFANY ANN (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 LEMON B RD
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTER
Mailing Address - State:LA
Mailing Address - Zip Code:70777-3603
Mailing Address - Country:US
Mailing Address - Phone:985-247-3275
Mailing Address - Fax:
Practice Address - Street 1:8604 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-6672
Practice Address - Country:US
Practice Address - Phone:225-635-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3092282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer