Provider Demographics
NPI:1508385717
Name:TIPPIN, KRISTA (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:TIPPIN
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 1:50 N MEDICAL DRIVE SOM 1R73
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-2885
Mailing Address - Fax:801-585-6234
Practice Address - Street 1:50 N MEDICAL DRIVE SOM 1R73
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2885
Practice Address - Fax:801-585-6234
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10467522-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist