1902429558 NPI number — ERIC SIPE OTR/L

Table of content: ERIC SIPE OTR/L (NPI 1902429558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902429558 NPI number — ERIC SIPE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIPE
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902429558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6160 CORNERSTONE CT E STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-216-8837
Provider Business Mailing Address Fax Number:
619-947-0276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 N BRAND BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-286-2600
Provider Business Practice Location Address Fax Number:
747-204-0181
Provider Enumeration Date:
05/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  106092 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 21726 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 427800 . This is a "NBCOT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106092 . This is a "MINNESOTA BOARD OF OCCUPATIONAL THERAPY PRACTICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21726 . This is a "CALIFORNIA BOARD OF OCCUPATIONAL THERAPY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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