Provider Demographics
NPI:1962858910
Name:LAU, TIFFANY WAI CHEE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:WAI CHEE
Last Name:LAU
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 1:188 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1491
Mailing Address - Country:US
Mailing Address - Phone:415-518-2365
Mailing Address - Fax:
Practice Address - Street 1:188 BONNIE LN
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1491
Practice Address - Country:US
Practice Address - Phone:415-518-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT15383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist