Basic Information
| Provider Information | |||||||||
| NPI: | 1447694310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIPPETT | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 NEWPORT DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210501758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108382200 | ||||||||
| FaxNumber: | 4108383300 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 NEWPORT DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210501758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108382200 | ||||||||
| FaxNumber: | 4108383300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 01608 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.