Healthcare Provider Details

I. General information

NPI: 1235362047
Provider Name (Legal Business Name): SHIFRA GIBBER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5228
US

IV. Provider business mailing address

233 WOEHR AVE
LAKEWOOD NJ
08701-3476
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-3772
  • Fax:
Mailing address:
  • Phone: 732-901-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00301100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: