Provider Demographics
NPI:1376369389
Name:TIFFIN, SUSAN RENEE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:TIFFIN
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 1:837 E LOWER SPRINGBORO RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9388
Mailing Address - Country:US
Mailing Address - Phone:863-257-1823
Mailing Address - Fax:
Practice Address - Street 1:837 E LOWER SPRINGBORO RD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9388
Practice Address - Country:US
Practice Address - Phone:863-257-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist