Provider Demographics
NPI:1063047884
Name:KIPTOO, EDWIN K (OTA)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:K
Last Name:KIPTOO
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:270 UNION ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1348
Mailing Address - Country:US
Mailing Address - Phone:978-203-9191
Mailing Address - Fax:978-203-9195
Practice Address - Street 1:270 UNION ST STE 304
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1348
Practice Address - Country:US
Practice Address - Phone:978-203-9191
Practice Address - Fax:978-203-9195
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4565224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant