Provider Demographics
NPI:1245377381
Name:SHIPKIN, DEBORAH ANN (OT)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:SHIPKIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-0130
Mailing Address - Country:US
Mailing Address - Phone:508-696-9171
Mailing Address - Fax:508-696-0770
Practice Address - Street 1:170 POND RD
Practice Address - Street 2:
Practice Address - City:WEST TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02575-0130
Practice Address - Country:US
Practice Address - Phone:508-696-9171
Practice Address - Fax:508-696-0770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4966225X00000X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68302Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST