Provider Demographics
NPI:1871685560
Name:TIPTON, ALLISON (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:DELANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9300
Mailing Address - Country:US
Mailing Address - Phone:307-587-9789
Mailing Address - Fax:307-587-9787
Practice Address - Street 1:544 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9300
Practice Address - Country:US
Practice Address - Phone:307-587-9789
Practice Address - Fax:307-587-9787
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR310225X00000X
WYOTR-310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401700Medicaid
WA192552OtherWORK COMP
WY670002233OtherRAIL ROAD MEDICARE
WY315270OtherBLUE CROSS BLUE SHIELD
WY118757100Medicaid
WY670002233OtherRAIL ROAD MEDICARE
WY315270OtherBLUE CROSS BLUE SHIELD