Provider Demographics
NPI:1619657384
Name:PIPKIN, LINETTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:PIPKIN
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 1:200 BRIGHTLY WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3415
Mailing Address - Country:US
Mailing Address - Phone:618-978-7061
Mailing Address - Fax:
Practice Address - Street 1:200 BRIGHTLY WAY
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3415
Practice Address - Country:US
Practice Address - Phone:618-978-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant