Healthcare Provider Details

I. General information

NPI: 1598978116
Provider Name (Legal Business Name): KRISTINA JANE SHIPMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HWY 27
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

2400 S HWY 27
CLERMONT FL
34711-6816
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone: 352-394-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 9855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: