Individual
TIFFANY MATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 3RD ST SE, FORT WALTON BEACH, FL 32548-5401
(850) 243-6134
Mailing address
1625 BEL AIRE DR, CRESTVIEW, FL 32536-3242
(563) 271-1839
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32374
FL
Other
Enumeration date
09/07/2018
Last updated
09/07/2018
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