Provider Demographics
NPI:1548625775
Name:GILPIN, DESTINY SHAE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:SHAE
Last Name:GILPIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FORWARD PASS TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2006
Mailing Address - Country:US
Mailing Address - Phone:850-766-1683
Mailing Address - Fax:
Practice Address - Street 1:6410 FORWARD PASS TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2006
Practice Address - Country:US
Practice Address - Phone:850-766-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist