Provider Demographics
NPI:1235482308
Name:TIPTON, KENT ALAN (TEACHING CREDNTIAL)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:ALAN
Last Name:TIPTON
Suffix:
Gender:M
Credentials:TEACHING CREDNTIAL
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:100 N RODEO GULCH RD
Mailing Address - Street 2:SPC. 97
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2047
Mailing Address - Country:US
Mailing Address - Phone:831-476-7987
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3565
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist