Provider Demographics
NPI:1841493210
Name:WHIPPLE, LIANN T (MT)
Entity type:Individual
Prefix:MRS
First Name:LIANN
Middle Name:T
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SW 28TH ST
Mailing Address - Street 2:VILLA #58
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5703
Mailing Address - Country:US
Mailing Address - Phone:863-763-9711
Mailing Address - Fax:863-357-4912
Practice Address - Street 1:306 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2949
Practice Address - Country:US
Practice Address - Phone:863-357-4994
Practice Address - Fax:863-357-4912
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist