Provider Demographics
NPI:1902662893
Name:ROBB, TIFFANY (THERAPY REC TECH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ROBB
Suffix:
Gender:F
Credentials:THERAPY REC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-2202
Mailing Address - Country:US
Mailing Address - Phone:435-623-1721
Mailing Address - Fax:
Practice Address - Street 1:1100 N 400 E
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-2202
Practice Address - Country:US
Practice Address - Phone:435-623-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11762607-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist