Individual
MRS. TIFFANY LOUISE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1501 WOODLAWN DR, APT. #1, CHARLESTON, IL 61920-4262
(906) 290-2429
Mailing address
1501 WOODLAWN DR, APT. #1, CHARLESTON, IL 61920-4262
(906) 290-2429
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
02/28/2012
Last updated
02/28/2012
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