Tiffany Vang-Sutton, OTD

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

106799 Issued in MN

Practice address

5985 Rice Creek Pkwy Ste 205
Shoreview, MN 55126-5037

Phone

(612) 888-4757

NPI assigned

Jun 24, 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

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fundamental Kids Therapy LLC

  • Speech-Language Pathologist
  • Shoreview, MN
  • NPI 1922443522
  Medicare reassignment

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1700620655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5985 RICE CREEK PKWY STE 205",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265037",
            "telephone_number": "612-888-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5985 RICE CREEK PKWY STE 205",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265037",
            "telephone_number": "612-888-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANG-SUTTON",
        "first_name": "TIFFANY",
        "name_prefix": "Dr.",
        "credential": "OTD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Michael Uher, PHARM.D.
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• Rebecca Jean Vanderwerf, ATC
• Adrec Chen-Zen HWJ-Chim Vang
• Vania Complete Care LLC
• Patrick Varro, PH.D.
• Vaughn R Jefferson PSYD Mdiv LP LLC
• Veritas Counseling PLLC

• Occupational Therapist in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.