Healthcare Provider Details

I. General information

NPI: 1568520641
Provider Name (Legal Business Name): KIPP AARON CLAYTON O.T.-R.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 US HIGHWAY 90 W STE. 2
CASTROVILLE TX
78009-4540
US

IV. Provider business mailing address

209 US HIGHWAY 90 WEST SUITE 2
CASTROVILLE TX
78009-4555
US

V. Phone/Fax

Practice location:
  • Phone: 830-931-2211
  • Fax: 830-538-3778
Mailing address:
  • Phone: 830-931-2211
  • Fax: 830-538-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: