TIFFANY STATHAM

POCATELLO, ID
NPI1689553075
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy222Q00000X Developmental Therapist
Additional Taxonomies106S00000X Behavior Technician
Enumeration Date2025-08-29
Last Update Date2025-09-02
Business Address
TIFFANY STATHAM
737 W WHITMAN ST
POCATELLO, ID 83204-4203
Phone number: 208-241-6456
Mailing Address
TIFFANY STATHAM
737 W WHITMAN ST
POCATELLO, ID 83204-4203
Phone number: 208-241-6456