Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OC000619L | PA |
NPI | 1013047968 |
---|---|
Provider Name | Ms. Donna Walton-Gibbs |
First Address | Lancaster, PA 17603-9615 |
Second Address | Lancaster, PA 17601-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017724790004 | 17 (01) | PA |