Provider Demographics
NPI:1508334384
Name:SCHIPPER, LAISEE (PTA)
Entity Type:Individual
Prefix:
First Name:LAISEE
Middle Name:
Last Name:SCHIPPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2437
Mailing Address - Country:US
Mailing Address - Phone:781-294-4461
Mailing Address - Fax:
Practice Address - Street 1:105 RESEARCH RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4322
Practice Address - Country:US
Practice Address - Phone:781-740-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6142OtherPTA LICENSE