Provider Demographics
NPI:1821602848
Name:HAWN, TIFFANY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:HAWN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 CUMBERLAND MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SUNBRIGHT
Mailing Address - State:TN
Mailing Address - Zip Code:37872-2810
Mailing Address - Country:US
Mailing Address - Phone:423-215-6520
Mailing Address - Fax:
Practice Address - Street 1:116 CUMBERLAND ST.
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3788
Practice Address - Country:US
Practice Address - Phone:423-215-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2299224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant