Provider Demographics
NPI:1871842625
Name:DEAN, TIFFANY DIANE (COTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:DEAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 OCEANVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1936
Mailing Address - Country:US
Mailing Address - Phone:516-639-2493
Mailing Address - Fax:
Practice Address - Street 1:44 OCEANVIEW AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1936
Practice Address - Country:US
Practice Address - Phone:516-639-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008159224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant