Provider Demographics
NPI:1366804171
Name:UBELHOR, TIFFANI (ATC)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:UBELHOR
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 1:600 W 13TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1881
Mailing Address - Country:US
Mailing Address - Phone:812-482-7442
Mailing Address - Fax:
Practice Address - Street 1:600 W 13TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1881
Practice Address - Country:US
Practice Address - Phone:812-482-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002007A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer