Provider Demographics
NPI:1659680551
Name:WHALEN, TIFFANY ANNE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:ANNE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:900 LAKEWOOD AVE
Mailing Address - Street 2:OFFICE OF ATHLETIC TRAINING
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2600
Mailing Address - Country:US
Mailing Address - Phone:732-987-2687
Mailing Address - Fax:732-987-2031
Practice Address - Street 1:900 LAKEWOOD AVE
Practice Address - Street 2:OFFICE OF ATHLETIC TRAINING
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2600
Practice Address - Country:US
Practice Address - Phone:732-987-2687
Practice Address - Fax:732-987-2031
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MT001664002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer