Provider Demographics
NPI:1720533656
Name:BENOIT, TIFFANY (COTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HAMPSHIRE DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9732
Mailing Address - Country:US
Mailing Address - Phone:920-277-1381
Mailing Address - Fax:919-300-7993
Practice Address - Street 1:149 BRENTFIELD LOOP
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6879
Practice Address - Country:US
Practice Address - Phone:919-525-6750
Practice Address - Fax:919-300-7993
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9209224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant