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General NPI Number Information
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NPI Number | 1629318761
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Entity Type | Individual
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Provider Name | ANDREA JO HAPPLI MS ATC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 500 GRAND AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4967
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Country | US
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Telephone | 201-569-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 590 COUNTY ROAD O
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City | MOSINEE
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State | WI
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Zip | 54455-9303
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Country | US
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Telephone | 715-571-0570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00178100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002423-1
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License Number State | NY
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