Provider Demographics
NPI:1891003133
Name:RYAN, TIFFANY (OTR)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 LYNNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1113
Mailing Address - Country:US
Mailing Address - Phone:817-437-8526
Mailing Address - Fax:
Practice Address - Street 1:3501 N MACARTHUR BLVD
Practice Address - Street 2:STE 650
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3651
Practice Address - Country:US
Practice Address - Phone:214-260-3197
Practice Address - Fax:214-260-8602
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX106904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist