Provider Demographics
NPI:1689903817
Name:SPELLER, TIFFANI CHANEL (MSA)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:CHANEL
Last Name:SPELLER
Suffix:
Gender:F
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 WOODHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8365
Mailing Address - Country:US
Mailing Address - Phone:317-755-9963
Mailing Address - Fax:
Practice Address - Street 1:3132 WOODHAVEN WAY
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8365
Practice Address - Country:US
Practice Address - Phone:317-755-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies