Provider Demographics
NPI:1689049934
Name:SHIPPA, JODY (MS OTR)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:
Last Name:SHIPPA
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-3174
Mailing Address - Country:US
Mailing Address - Phone:540-955-6312
Mailing Address - Fax:
Practice Address - Street 1:1010 PARSHALL RD
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-3174
Practice Address - Country:US
Practice Address - Phone:540-955-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist