Healthcare Provider Details

I. General information

NPI: 1063845030
Provider Name (Legal Business Name): TAHEERAH BAHEEJAH RAHIM-GIBSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5463 MCCULLOUGH DR APT C
COLORADO SPRINGS CO
80902-1679
US

IV. Provider business mailing address

5463 MCCULLOUGH DR APT C
COLORADO SPRINGS CO
80902-1679
US

V. Phone/Fax

Practice location:
  • Phone: 808-227-1808
  • Fax:
Mailing address:
  • Phone: 808-227-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5626
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT-574
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRTL0005361
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-16-21790
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: