Provider Demographics
NPI:1487874806
Name:MCGOWN, TIFFANY C (COTA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:MCGOWN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11077 STATE ROAD 3 APT 112
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0236
Mailing Address - Country:US
Mailing Address - Phone:260-446-5179
Mailing Address - Fax:
Practice Address - Street 1:11077 STATE ROAD 3 APT 112
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-0236
Practice Address - Country:US
Practice Address - Phone:260-446-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001243A224Z00000X
FLOTA 10375224Z00000X
OHOTA 03454224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant