Provider Demographics
NPI:1821452632
Name:KUSI-DAVIES, TIFFANY (OTR/L)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KUSI-DAVIES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 POTOMAC HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4662
Mailing Address - Country:US
Mailing Address - Phone:301-803-0019
Mailing Address - Fax:
Practice Address - Street 1:1578 POTOMAC HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4662
Practice Address - Country:US
Practice Address - Phone:301-803-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist