Provider Demographics
NPI:1255701546
Name:MORTON, TIFFANY NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MORTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:TLIFFANY
Other - Middle Name:NICOLE
Other - Last Name:MORTON JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 W ARMOUR BLVD
Mailing Address - Street 2:APT 620
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2072
Mailing Address - Country:US
Mailing Address - Phone:334-332-9400
Mailing Address - Fax:
Practice Address - Street 1:1 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-1651
Practice Address - Country:US
Practice Address - Phone:816-920-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL36522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer