Provider Demographics
NPI:1679278154
Name:TIPTON, WHITNEY CAMILE (OTR/L)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:CAMILE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WHITSON DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3851
Mailing Address - Country:US
Mailing Address - Phone:828-385-1610
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 425
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7587
Practice Address - Country:US
Practice Address - Phone:423-212-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist