Provider Demographics
NPI:1578137444
Name:LIPSCOMB, LAURIE ANN (LMT, MMT, BCTMB)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:ANN
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:LMT, MMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-3819
Mailing Address - Country:US
Mailing Address - Phone:304-276-2169
Mailing Address - Fax:
Practice Address - Street 1:1521 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-3819
Practice Address - Country:US
Practice Address - Phone:304-276-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011-2815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist