TIFFANY STATHAM

Developmental Therapist

Active Individual
NPI: 1689553075

Practice Address

737 W WHITMAN ST
Pocatello, ID 83204

Phone: (208) 241-6456

Specialties

Specialty Code Primary License
Behavior Technician 106S00000X No -
Developmental Therapist 222Q00000X Yes -

Frequently Asked Questions

NPI 1689553075 is the National Provider Identifier for TIFFANY STATHAM, a Developmental Therapist provider located in Pocatello, ID. This NPI was enumerated on August 29, 2025.
TIFFANY STATHAM practices at 737 W WHITMAN ST, Pocatello, ID 83204.

Quick Facts

NPI
1689553075
Type
Individual
Enumerated
Aug 29, 2025
Last Updated
Sep 2, 2025

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