Provider Demographics
NPI:1619172152
Name:MORLAND, TIFFANY R
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:R
Last Name:MORLAND
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 1:831 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3054
Mailing Address - Country:US
Mailing Address - Phone:309-371-5252
Mailing Address - Fax:
Practice Address - Street 1:831 HARRISON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3054
Practice Address - Country:US
Practice Address - Phone:309-371-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist