Provider Demographics
NPI:1275258626
Name:HIPPELY, ABIGAIL S (AT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:S
Last Name:HIPPELY
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1453
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-1453
Mailing Address - Country:US
Mailing Address - Phone:831-316-9042
Mailing Address - Fax:831-316-9040
Practice Address - Street 1:317 POTRERO ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-7611
Practice Address - Country:US
Practice Address - Phone:831-425-9500
Practice Address - Fax:831-316-9040
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000502452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer