Provider Demographics
NPI:1154877652
Name:CRIPE, CAMDEN (ATC)
Entity type:Individual
Prefix:
First Name:CAMDEN
Middle Name:
Last Name:CRIPE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:OREANA
Mailing Address - State:IL
Mailing Address - Zip Code:62554-9775
Mailing Address - Country:US
Mailing Address - Phone:217-972-1884
Mailing Address - Fax:
Practice Address - Street 1:7 VIEW CIR
Practice Address - Street 2:
Practice Address - City:OREANA
Practice Address - State:IL
Practice Address - Zip Code:62554-9775
Practice Address - Country:US
Practice Address - Phone:217-972-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer