Provider Demographics
NPI:1295074599
Name:DAWSON, TIFFANY BRIEANNE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:BRIEANNE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CLYDESDALE DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4825
Mailing Address - Country:US
Mailing Address - Phone:570-772-4412
Mailing Address - Fax:
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1125
Practice Address - Country:US
Practice Address - Phone:540-459-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000589224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant