Provider Demographics
NPI:1427835990
Name:DIAL, TIFFANY FRANCES (OT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FRANCES
Last Name:DIAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 N GATEWAY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9805
Mailing Address - Country:US
Mailing Address - Phone:435-701-7010
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9805
Practice Address - Country:US
Practice Address - Phone:435-701-7010
Practice Address - Fax:435-701-7012
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13489613-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist