Healthcare Provider Details

I. General information

NPI: 1861829178
Provider Name (Legal Business Name): ASHLEY R GIBBS BCBA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY R GLEIT

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11539 PARK WOODS CIR STE 250
ALPHARETTA GA
30005
US

IV. Provider business mailing address

PO BOX 399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 678-527-3224
  • Fax: 678-366-5886
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT005770
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: