Individual
MRS. LISA ANN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR
Contact information
Practice address
1200 BARR ST, FORT WAYNE, IN 46802-3502
(260) 467-1110
Mailing address
725 N EASTON DR, ANGOLA, IN 46703-7566
(260) 665-8415
(260) 665-8415
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
31004899A
IN
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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