Individual
TIFFANY NICOLE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
825 SUMMIT ST, SPENCER, WV 25276-1035
(304) 923-4175
Mailing address
600 MARKET ST, APT. #2, SPENCER, WV 25276-1831
(304) 923-4175
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1594
WV
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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