Provider Demographics
NPI:1962225300
Name:DOBBINS, TIFFANY LOGAN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LOGAN
Last Name:DOBBINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2620
Mailing Address - Country:US
Mailing Address - Phone:276-352-4465
Mailing Address - Fax:276-293-1212
Practice Address - Street 1:1608 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1681
Practice Address - Country:US
Practice Address - Phone:276-352-4465
Practice Address - Fax:276-293-1212
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist