Individual
TIFFANY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7950 MILLHAVEN RD, MONROE, LA 71203-9008
(318) 737-1117
Mailing address
7950 MILLHAVEN RD, MONROE, LA 71203-9008
(318) 737-1117
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
307722
LA
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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