Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 004990 | OH |
N | 225XG0600X | Occupational Therapist - Gerontology | OT 004990 | OH |
NPI | 1689823320 |
---|---|
Provider Name | Saundra J Light Gibbons |
First Address | Beachwood, OH 44122-0993 |
Second Address | Maple Heights, OH 44137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 07/08/2020 |