Individual
JASON GIBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
69 LONGVIEW DR, TIJERAS, NM 87059-7835
(505) 281-0237
(505) 281-0237
Mailing address
69 LONGVIEW DR, TIJERAS, NM 87059-7835
(505) 407-5703
(505) 407-5703
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2238
NM
225X00000X
Occupational Therapist
Primary
5578
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47735066
—
NM
Enumeration date
09/10/2007
Last updated
12/17/2024
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