Individual
MRS. AMANDA LEE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1606 HUNT DR, NORMAL, IL 61761-2192
(309) 451-0069
Mailing address
595 BASSWOOD LN, NORMAL, IL 61761-5749
(630) 272-0311
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056006623
IL
225XP0200X
Pediatric Occupational Therapist
Primary
056006623
IL
Other
Enumeration date
12/26/2006
Last updated
10/17/2011
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