Provider Demographics
NPI:1992523963
Name:DWINELL, TIANNA ELIZABETH
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:ELIZABETH
Last Name:DWINELL
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 1:224 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9417
Mailing Address - Country:US
Mailing Address - Phone:413-206-8783
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1199
Practice Address - Country:US
Practice Address - Phone:413-206-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist