Provider Demographics
NPI:1154501823
Name:CRIPPS, SHELIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:CRIPPS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6032
Mailing Address - Country:US
Mailing Address - Phone:479-254-6717
Mailing Address - Fax:
Practice Address - Street 1:1004 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6032
Practice Address - Country:US
Practice Address - Phone:479-254-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A591405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1154501823Medicaid