Provider Demographics
NPI:1023239548
Name:LIPPINCOTT, JEREMY W (LMT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:W
Last Name:LIPPINCOTT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 LINDEN CRK
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8466
Mailing Address - Country:US
Mailing Address - Phone:937-441-9783
Mailing Address - Fax:
Practice Address - Street 1:834 LINDEN CRK
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8466
Practice Address - Country:US
Practice Address - Phone:937-441-9783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist