Provider Demographics
NPI:1861737306
Name:BURGESS, TIFFANY MONIQUE (OTR/L)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 PLANK DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-7077
Mailing Address - Country:US
Mailing Address - Phone:502-551-2418
Mailing Address - Fax:
Practice Address - Street 1:925 SOUTH SEMORAN BOULEVARD SUITE 108
Practice Address - Street 2:NATIONAL STAFFING SOLUTIONS
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:800-521-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4482225X00000X
IN31004951A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist