Provider Demographics
NPI:1023617990
Name:SCHIPPER, BETH ANDREA
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANDREA
Last Name:SCHIPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6801
Mailing Address - Country:US
Mailing Address - Phone:616-218-8614
Mailing Address - Fax:
Practice Address - Street 1:2717 104TH AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-6801
Practice Address - Country:US
Practice Address - Phone:616-218-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist