Individual
MISS TIFFANY ELMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
751 CHOCTAW ST, GRENADA, MS 38901-5317
(601) 201-8371
Mailing address
751 CHOCTAW ST, GRENADA, MS 38901-5317
(601) 201-8371
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2569
MS
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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