Provider Demographics
NPI:1053551549
Name:PHILLIPS, CHRISTINA MARIE TIPPLE (OT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE TIPPLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:TIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:82 CLOISTERBANE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8224
Mailing Address - Country:US
Mailing Address - Phone:904-553-3713
Mailing Address - Fax:
Practice Address - Street 1:1690 US HIGHWAY 1 S STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6024
Practice Address - Country:US
Practice Address - Phone:904-810-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT13521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist