Individual
THERESA GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 BARTLEY RD, JACKSON, NJ 08527-1241
(908) 596-0921
Mailing address
12 LIBERTY PL, JACKSON, NJ 08527-2241
(908) 596-0921
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09079400
NJ
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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