Provider Demographics
NPI:1871962555
Name:STAPLETON, TIFFANY M (ATC)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:M
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 DORIS ST
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-7738
Mailing Address - Country:US
Mailing Address - Phone:845-706-0576
Mailing Address - Fax:
Practice Address - Street 1:1910 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6027
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer