Individual
TIFFANY ICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
312 SOLLEY DR, BALLWIN, MO 63021-5248
(636) 391-0666
Mailing address
312 SOLLEY DR, BALLWIN, MO 63021-5248
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2008027075
MO
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
03/17/2014
Last updated
09/15/2023
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