Provider Demographics
NPI:1336232131
Name:FRITZ, TIFFANY M (OTR)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:FRITZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:14194 STACEY ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8720
Mailing Address - Country:US
Mailing Address - Phone:317-753-6962
Mailing Address - Fax:
Practice Address - Street 1:14194 STACEY ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8720
Practice Address - Country:US
Practice Address - Phone:317-753-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004103A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist