Provider Demographics
NPI:1700121209
Name:LIPSKI, DANIELLE RONQUILLE (MOT, OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RONQUILLE
Last Name:LIPSKI
Suffix:
Gender:F
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BROAD AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2445
Mailing Address - Country:US
Mailing Address - Phone:228-575-2906
Mailing Address - Fax:228-865-3058
Practice Address - Street 1:1340 BROAD AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2404
Practice Address - Country:US
Practice Address - Phone:228-575-1234
Practice Address - Fax:228-575-1240
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist