Provider Demographics
NPI:1578858361
Name:SPOONER, TIFFANY S (MS OT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:SPOONER
Suffix:
Gender:
Credentials:MS OT
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4300 JUNIPER DAIRY CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8307
Mailing Address - Country:US
Mailing Address - Phone:314-322-6159
Mailing Address - Fax:
Practice Address - Street 1:113 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4853
Practice Address - Country:US
Practice Address - Phone:910-891-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC7710225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology