Provider Demographics
NPI:1508470295
Name:LARKIN, TIFFANY RAE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:LARKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 NEW MOON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-3775
Mailing Address - Country:US
Mailing Address - Phone:347-432-8082
Mailing Address - Fax:
Practice Address - Street 1:3427 NEW MOON ST
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-3775
Practice Address - Country:US
Practice Address - Phone:201-448-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01362800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist