Provider Demographics
NPI:1679944680
Name:HIPP, ERICA K (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:K
Last Name:HIPP
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 1:345 MYRTLE AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3266
Mailing Address - Country:US
Mailing Address - Phone:262-880-0079
Mailing Address - Fax:
Practice Address - Street 1:345 MYRTLE AVE
Practice Address - Street 2:APT 3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3266
Practice Address - Country:US
Practice Address - Phone:262-880-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist