Provider Demographics
NPI:1508183898
Name:DANSE, TIFFANY ANN C
Entity Type:Individual
Prefix:
First Name:TIFFANY ANN
Middle Name:C
Last Name:DANSE
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 1:2335 SE PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1641
Mailing Address - Country:US
Mailing Address - Phone:207-240-1565
Mailing Address - Fax:
Practice Address - Street 1:2335 SE PINE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1641
Practice Address - Country:US
Practice Address - Phone:207-240-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR258582225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist