Individual
ANGEL S GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1925 ESSEX FARMS DR, CHARLESTON, SC 29414-6696
(843) 779-1685
Mailing address
1114 FLYWAY RD, SUMMERVILLE, SC 29483-8021
(803) 316-1227
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5174
SC
225X00000X
Occupational Therapist
5174
SC
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
06/06/2023
Last updated
10/19/2023
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