Provider Demographics
NPI:1932742475
Name:ALFORD, TRISTIN
Entity Type:Individual
Prefix:
First Name:TRISTIN
Middle Name:
Last Name:ALFORD
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 1:1127 E NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5375
Mailing Address - Country:US
Mailing Address - Phone:352-589-5595
Mailing Address - Fax:
Practice Address - Street 1:1127 E NORTH BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5375
Practice Address - Country:US
Practice Address - Phone:352-589-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant