Individual
BROOKE LAUREN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
114 PENLAND ST, ELLIJAY, GA 30540-0487
(706) 914-2483
Mailing address
175 BOARDTOWN RD UNIT B, ELLIJAY, GA 30540-2354
(478) 662-8137
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002788
GA
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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