Provider Demographics
NPI:1245739747
Name:HAFNER, TIERNEY ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:ROSE
Last Name:HAFNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSETREE CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1550
Mailing Address - Country:US
Mailing Address - Phone:215-584-2093
Mailing Address - Fax:
Practice Address - Street 1:4674 BERWYN LN
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8251
Practice Address - Country:US
Practice Address - Phone:610-662-4372
Practice Address - Fax:610-465-9692
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist