Provider Demographics
NPI:1215317755
Name:THORSEN, TIFFANY MARIE
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:MARIE
Last Name:THORSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 SW MULTNOMAH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3195
Mailing Address - Country:US
Mailing Address - Phone:503-244-1107
Mailing Address - Fax:
Practice Address - Street 1:5701 SW MULTNOMAH BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3195
Practice Address - Country:US
Practice Address - Phone:503-244-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant