Provider Demographics
NPI:1720160070
Name:PIPPEN, LORI MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARIE
Last Name:PIPPEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567-0186
Mailing Address - Country:US
Mailing Address - Phone:903-585-3322
Mailing Address - Fax:903-585-2915
Practice Address - Street 1:1710 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1858
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:903-793-0058
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1547225XP0200X
TX109611225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021289601Medicaid