Provider Demographics
NPI:1194280503
Name:SHIPLEY, LOREN C (ATC)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:C
Last Name:SHIPLEY
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:RICKETTS HALL
Mailing Address - Street 2:566 BROWNSON ROAD
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402
Mailing Address - Country:US
Mailing Address - Phone:410-293-4487
Mailing Address - Fax:
Practice Address - Street 1:WESLEY BROWN FIELD HOUSE
Practice Address - Street 2:151 COOPER ROAD, ROOM 125
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-2140
Practice Address - Country:US
Practice Address - Phone:410-293-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer