Active NPI
Tiffany Statham
- Developmental Therapist
- Pocatello, ID
National Provider Identifier
1689553075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 737 W Whitman St
Pocatello, ID 83204-4203 - Phone
- (208) 241-6456
- NPI assigned
- Aug 29, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
737 W Whitman St
Pocatello, ID 83204-4203
Mailing address
737 W Whitman St
Pocatello, ID 83204-4203
Phone (208) 241-6456
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756771200000",
"number": "1689553075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "737 W WHITMAN ST",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832044203",
"telephone_number": "208-241-6456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "737 W WHITMAN ST",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832044203",
"telephone_number": "208-241-6456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATHAM",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-29",
"last_updated": "2025-09-02",
"certification_date": "2025-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.