Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201008330 | MI |
NPI | 1003389800 |
---|---|
Provider Name | Leah Gibson |
First Address | Grand Rapids, MI 49505-4270 |
Second Address | Grand Rapids, MI 49546-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2019 |
Last Update Date | 09/11/2020 |