Provider Demographics
NPI:1467740639
Name:TIPPENHAUER, MARIE MICHAEL (ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MICHAEL
Last Name:TIPPENHAUER
Suffix:
Gender:F
Credentials:ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 BEECHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5012
Mailing Address - Country:US
Mailing Address - Phone:954-217-3056
Mailing Address - Fax:
Practice Address - Street 1:12301 TAFT ST STE 200
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4387
Practice Address - Country:US
Practice Address - Phone:954-312-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11635224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant