Provider Demographics
NPI:1114550787
Name:COLLINS, TIFFANI LYNETTE (COTA/L)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:LYNETTE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 KIM ST E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3913
Mailing Address - Country:US
Mailing Address - Phone:870-208-6883
Mailing Address - Fax:
Practice Address - Street 1:615 CANAL AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3003
Practice Address - Country:US
Practice Address - Phone:870-238-2233
Practice Address - Fax:870-208-8255
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1576224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant