Healthcare Provider Details

I. General information

NPI: 1114518214
Provider Name (Legal Business Name): ISABELL GIBBON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date: 08/13/2026
Reactivation Date: 09/02/2026

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-725-2000
  • Fax:
Mailing address:
  • Phone: 612-725-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108203
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: