Healthcare Provider Details

I. General information

NPI: 1972749026
Provider Name (Legal Business Name): JONATHAN O. KIPPINS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 BRYSON LN
LIBERTY TOWNSHIP OH
45044-2523
US

IV. Provider business mailing address

5705 BRYSON LN
LIBERTY TOWNSHIP OH
45044-2523
US

V. Phone/Fax

Practice location:
  • Phone: 419-350-0029
  • Fax:
Mailing address:
  • Phone: 419-350-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.03629
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT.008361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: