Provider Demographics
NPI:1962440735
Name:SAMPSON, TIFFANY KELLEY (OTR L, BCP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:KELLEY
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:OTR L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24242 LA CRESTA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2561
Mailing Address - Country:US
Mailing Address - Phone:949-496-3363
Mailing Address - Fax:
Practice Address - Street 1:24242 LA CRESTA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2561
Practice Address - Country:US
Practice Address - Phone:949-496-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 319225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics