Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OC004131L | PA |
NPI | 1356553697 |
---|---|
Provider Name | Alicia M Tifft |
First Address | Paoli, PA 19301-1937 |
Second Address | Malvern, PA 19355-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |