Provider Demographics
NPI:1841439247
Name:HABICHT, TIFFANY L (COTA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:HABICHT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:I
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:313 HAZEL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4935
Mailing Address - Country:US
Mailing Address - Phone:814-230-8451
Mailing Address - Fax:
Practice Address - Street 1:313 HAZEL ST APT 3
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4935
Practice Address - Country:US
Practice Address - Phone:814-230-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007199-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant