Provider Demographics
NPI:1467499517
Name:WIPPERMAN, JEAN L (LRT, CTRS)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:L
Last Name:WIPPERMAN
Suffix:
Gender:F
Credentials:LRT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:PM&RS 117
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-6874
Mailing Address - Fax:919-416-5913
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:PM&RS 117
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6874
Practice Address - Fax:919-416-5913
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC561225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist