Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1629255690 |
---|---|
Provider Name | Sharon Lynn Gibson |
First Address | Poteau, OK 74953-3807 |
Second Address | Poteau, OK 74953-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 11/12/2009 |