Provider Demographics
NPI:1497401558
Name:STIPP, ASHLYN MICHELE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:MICHELE
Last Name:STIPP
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 CONNECTICUT RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-2239
Mailing Address - Country:US
Mailing Address - Phone:620-212-5539
Mailing Address - Fax:
Practice Address - Street 1:1165 CONNECTICUT RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-2239
Practice Address - Country:US
Practice Address - Phone:620-212-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant