Individual
JAKE GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
326 SUMMERSET ST, FONTANELLE, IA 50846-8098
(615) 896-6400
(615) 896-5177
Mailing address
624 W NORTH ST, MADRID, IA 50156-1024
(615) 896-6400
(615) 896-5177
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
00306
IA
Other
Enumeration date
02/19/2008
Last updated
02/19/2008
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