Provider Demographics
NPI:1891427480
Name:COATES, TIFFANY SHLEASE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHLEASE
Last Name:COATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 293RD ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2133
Mailing Address - Country:US
Mailing Address - Phone:419-514-6843
Mailing Address - Fax:
Practice Address - Street 1:4850 293RD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2133
Practice Address - Country:US
Practice Address - Phone:419-514-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator