Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056-005719 | IL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201008929 | MI |
NPI | 1396054987 |
---|---|
Provider Name | Mrs. Tiffany Clare Sinovic |
First Address | Shelby Township, MI 48317-3268 |
Second Address | Fairview Heights, IL 62208-1342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 26/07/2019 |