Provider Demographics
NPI:1396833547
Name:KIPP, CYBIL A (MOT,OTR/L)
Entity Type:Individual
Prefix:
First Name:CYBIL
Middle Name:A
Last Name:KIPP
Suffix:
Gender:F
Credentials:MOT,OTR/L
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 38
Mailing Address - Street 2:100 MAIN STREET
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0038
Mailing Address - Country:US
Mailing Address - Phone:207-929-3831
Mailing Address - Fax:207-929-5955
Practice Address - Street 1:912 LONG PLAINS RD
Practice Address - Street 2:BUXTON CENTER ELEMENTARY SCHOOL
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-3208
Practice Address - Country:US
Practice Address - Phone:207-929-3836
Practice Address - Fax:207-929-9152
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist