Provider Demographics
NPI:1689407835
Name:TOEDT, TIFFANY ALEXANDRA (LCAT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALEXANDRA
Last Name:TOEDT
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ALEXANDRA
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4822
Mailing Address - Country:US
Mailing Address - Phone:315-729-9399
Mailing Address - Fax:
Practice Address - Street 1:10 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4822
Practice Address - Country:US
Practice Address - Phone:315-729-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002796221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist