Tiffany Joy Shedlock, MSS, OTR/L, CAPS

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

5201009305 Issued in MI

Practice address

400 Medical Park Dr
Watervliet, MI 49098-9225

Phone

(269) 463-6240

NPI assigned

Jan 17, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1245091289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2065 GRACE AVE",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094131",
            "telephone_number": "248-410-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-463-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEDLOCK",
        "first_name": "TIFFANY",
        "middle_name": "JOY",
        "credential": "MSS, OTR/L, CAPS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "MI",
            "license": "5201009305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trever Scott Portenga, PA-C
• Rodney Russell
• Sacred Heart Rehabilitation Center, Inc
• Megan Patricia Samples
• Ronald E Seagle, M.D.
• Celia Stenfors-Dacre, MD
• Sean W Sullivan, DO
• Lisa Sutton, MA, CCC/SLP
• Sarah L Thordarson, MD
• Tri City Medical Center

• All providers in Watervliet, MI
• Physical Rehabilitation Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.