Healthcare Provider Details

I. General information

NPI: 1992614952
Provider Name (Legal Business Name): LAURA GIBSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W LEMON AVE
ARCADIA CA
91007-7944
US

IV. Provider business mailing address

150 S 3RD AVE
ARCADIA CA
91006-3703
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-8351
  • Fax:
Mailing address:
  • Phone: 626-821-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: