Individual
KIM GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22757 72ND AVE S STE 102, KENT, WA 98032-2459
(253) 872-4118
Mailing address
31428 32ND AVE SW, FEDERAL WAY, WA 98023-7840
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OC00000976
LICENSE#
WA
Enumeration date
02/23/2007
Last updated
07/08/2007
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