Provider Demographics
NPI:1477163145
Name:TIPTON, MIRANDA SUE (OTD,OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:SUE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 GLEN ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9744
Mailing Address - Country:US
Mailing Address - Phone:941-713-2455
Mailing Address - Fax:
Practice Address - Street 1:6210 GLEN ABBEY LN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-9744
Practice Address - Country:US
Practice Address - Phone:941-713-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist