Provider Demographics
NPI:1437603222
Name:DOE, TYNISHA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TYNISHA
Middle Name:
Last Name:DOE
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 1:2681 ROOSEVELT BLVD
Mailing Address - Street 2:APT 4305
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2962
Mailing Address - Country:US
Mailing Address - Phone:207-610-0344
Mailing Address - Fax:
Practice Address - Street 1:1150 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1041
Practice Address - Country:US
Practice Address - Phone:727-585-5491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15805225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology