Provider Demographics
NPI:1255839072
Name:DALE, TIFFANY SIMS (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SIMS
Last Name:DALE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 QUILLIANS DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2885
Mailing Address - Country:US
Mailing Address - Phone:678-616-3099
Mailing Address - Fax:770-406-6840
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527
Practice Address - Country:US
Practice Address - Phone:678-616-3099
Practice Address - Fax:770-406-6840
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty