Provider Demographics
NPI:1801279492
Name:SWIM WHISPERERS SWIM SCHOOL NEW ENGLAND
Entity type:Organization
Organization Name:SWIM WHISPERERS SWIM SCHOOL NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILENE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:TISSER
Authorized Official - Suffix:
Authorized Official - Credentials:MA PT
Authorized Official - Phone:203-969-6431
Mailing Address - Street 1:1177 HIGH RIDGE RD STE 116
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1221
Mailing Address - Country:US
Mailing Address - Phone:203-545-0024
Mailing Address - Fax:
Practice Address - Street 1:1177 HIGH RIDGE RD STE 116
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1221
Practice Address - Country:US
Practice Address - Phone:203-545-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10221174400000X, 225X00000X
MA10846174400000X
MA9353174400000X
MA11053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty