Individual
MISS TIFFANY MARIE DAVID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6149 VICTORIA CT, MATTESON, IL 60443-1800
(773) 368-5288
Mailing address
6149 VICTORIA CT, MATTESON, IL 60443-1800
(773) 368-5288
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/22/2010
Last updated
03/22/2010
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