Provider Demographics
NPI:1922430768
Name:ESTES, TIFFANY M (AT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:ESTES
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 ELM PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9546
Mailing Address - Country:US
Mailing Address - Phone:614-582-5859
Mailing Address - Fax:
Practice Address - Street 1:1184 ELM PARK CIR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9546
Practice Address - Country:US
Practice Address - Phone:614-582-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AT 28352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer