Individual
TIFFANY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6950 GREENBRIAR DR, OWASSO, OK 74055-7388
(918) 519-2442
Mailing address
6950 GREENBRIAR DR, OWASSO, OK 74055-7388
Taxonomy
Speciality
Code
Description
License number
State
225XL0004X
Low Vision Occupational Therapist
OT571
OK
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
OT571
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200456840A
—
OK
Enumeration date
01/22/2012
Last updated
08/21/2019
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