Individual provider · Type 1 NPI
Tiffany Statham
Developmental Therapist · Pocatello, ID
Practice location
737 W Whitman St
Pocatello, ID 83204-4203
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Technician | 106S00000X | None listed |
| Developmental Therapist Primary | 222Q00000X | None listed |
Developmental Therapist: A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Deve…
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About NPI 1689553075
Tiffany Statham's National Provider Identifier is 1689553075, issued on Aug 29, 2025. The primary taxonomy on file is Developmental Therapist (222Q00000X), and the practice location is in Pocatello, ID. The record was last updated on Sep 2, 2025.