Healthcare Provider Details

I. General information

NPI: 1548186968
Provider Name (Legal Business Name): GRACIE IRENE COLE OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 BERRYHILL RD
MILTON FL
32570-8241
US

IV. Provider business mailing address

2547 ANGEL CT
GULF BREEZE FL
32563-5552
US

V. Phone/Fax

Practice location:
  • Phone: 850-626-9901
  • Fax:
Mailing address:
  • Phone: 850-203-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: