Individual
MS. GWENETTE BERYL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 OLD NORTHERN ROAD, ROSLYN, NY 11576
(516) 625-6846
Mailing address
581 PARK PLACE, BROOKLYN, NY 11238
(718) 230-4153
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
003868-1
—
Other
Enumeration date
07/23/2008
Last updated
07/23/2008
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