TIFFANY C MIMS

FORT WAYNE, IN
NPI1487874806
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: IN  32001243A)
Additional Taxonomies224Z00000X Occupational Therapy Assistant
(Licence: FL  OTA 10375)
224Z00000X Occupational Therapy Assistant
(Licence: OH  OTA 03454)
Enumeration Date2007-04-26
Last Update Date2007-07-08
Business Address
-- TIFFANY C MIMS COTA
6218 HOLGATE DR
FORT WAYNE, IN 46816-1521
Phone number: 260-348-3403
Mailing Address
-- TIFFANY C MIMS COTA
6218 HOLGATE DR
FORT WAYNE, IN 46816-1521
Phone number: 260-348-3403