Provider Demographics
NPI:1811738099
Name:STEWART, TIFFANY AMBER (CTRS, CDP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMBER
Last Name:STEWART
Suffix:
Gender:F
Credentials:CTRS, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 TROXEL DR S APT 205
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5830
Mailing Address - Country:US
Mailing Address - Phone:864-270-6903
Mailing Address - Fax:
Practice Address - Street 1:10914 TROXEL DR S APT 205
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5830
Practice Address - Country:US
Practice Address - Phone:864-270-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81743225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist