Provider Demographics
NPI:1649702911
Name:SIMPSON, TIFFANY MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials: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:PO BOX 10992
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0017
Mailing Address - Country:US
Mailing Address - Phone:479-831-8811
Mailing Address - Fax:
Practice Address - Street 1:1306 MILITARY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2911
Practice Address - Country:US
Practice Address - Phone:501-481-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist