Provider Demographics
NPI:1215993126
Name:LOEWE, TIFFANY A (OT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:LOEWE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BERNHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3568 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8408
Mailing Address - Country:US
Mailing Address - Phone:941-924-8868
Mailing Address - Fax:
Practice Address - Street 1:120 CAHABA VALLEY PKWY
Practice Address - Street 2:STE 100
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1185
Practice Address - Country:US
Practice Address - Phone:205-909-2540
Practice Address - Fax:205-682-3612
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004304225X00000X
AL3802225X00000X
FLOT13760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1780980540OtherGROUP NPI
AL1780980540OtherGROUP NPI