Provider Demographics
NPI:1427329937
Name:TIGUE, NATHAN WAYNE (COTA)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:WAYNE
Last Name:TIGUE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11215
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-0215
Mailing Address - Country:US
Mailing Address - Phone:352-678-7933
Mailing Address - Fax:
Practice Address - Street 1:16251 ROYALTON LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-3913
Practice Address - Country:US
Practice Address - Phone:352-678-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 12029224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant