Provider Demographics
NPI:1679944052
Name:TIPPERY, COURTNEY (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:TIPPERY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:GAMPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:515 N MARIA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3016
Mailing Address - Country:US
Mailing Address - Phone:814-569-7014
Mailing Address - Fax:
Practice Address - Street 1:1454 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3321
Practice Address - Country:US
Practice Address - Phone:814-266-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist