Provider Demographics
NPI:1962966580
Name:TIPSWORD, GEORGIA SUE (OT)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:SUE
Last Name:TIPSWORD
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 1:22923 BUCCANEER LN
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4248
Mailing Address - Country:US
Mailing Address - Phone:850-380-5428
Mailing Address - Fax:
Practice Address - Street 1:22923 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:CUDJOE KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4248
Practice Address - Country:US
Practice Address - Phone:850-380-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9720222Q00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist