Provider Demographics
NPI:1134211840
Name:TIPPETTS, CONNE R (OTR/L)
Entity type:Individual
Prefix:
First Name:CONNE
Middle Name:R
Last Name:TIPPETTS
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 1:639 W COULTER AVE
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2527
Mailing Address - Country:US
Mailing Address - Phone:307-754-9262
Mailing Address - Fax:307-754-9283
Practice Address - Street 1:639 W COULTER AVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2527
Practice Address - Country:US
Practice Address - Phone:307-754-9262
Practice Address - Fax:307-754-9283
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY310810OtherBLUE CROSS BLUE SHIELD
WA192550OtherWORK COMP
WY310810Medicare ID - Type Unspecified
WA192550OtherWORK COMP