Active NPI
Tiffany Camillucci, COTA/L
- Occupational Therapy Assistant
- Uncasville, CT
National Provider Identifier
1043677792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 001636
- Practice address
- 5 Richard Brown Dr
Uncasville, CT 06382-1141 - Phone
- (860) 848-8466
- NPI assigned
- Jan 26, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 001636 | CT | Primary |
Addresses
Primary practice location
5 Richard Brown Dr
Uncasville, CT 06382-1141
Mailing address
169 Baltic Rd
North Franklin, CT 06254-1406
Phone (860) 639-1437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001636 | CT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453766400000",
"number": "1043677792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 BALTIC RD",
"city": "NORTH FRANKLIN",
"state": "CT",
"postal_code": "062541406",
"telephone_number": "860-639-1437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 RICHARD BROWN DR",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063821141",
"telephone_number": "860-848-8466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMILLUCCI",
"first_name": "TIFFANY",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-26",
"last_updated": "2016-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CT",
"license": "001636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Uncasville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.