Provider Demographics
NPI:1477668556
Name:PATTERSON, TIFFANY P (MOT, OTRL)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:P
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:P
Other - Last Name:HARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT, OTRL
Mailing Address - Street 1:105 MARINER HEALTH WAY STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3251
Mailing Address - Country:US
Mailing Address - Phone:904-217-4259
Mailing Address - Fax:904-217-4251
Practice Address - Street 1:105 MARINER HEALTH WAY STE 213
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3251
Practice Address - Country:US
Practice Address - Phone:904-217-4259
Practice Address - Fax:904-217-4251
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10452225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00672041OtherRR MEDICARE
FLAJ452ZMedicare PIN