Healthcare Provider Details

I. General information

NPI: 1922421544
Provider Name (Legal Business Name): ANNE GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 CLARKWOOD PL
CINCINNATI OH
45208-1511
US

IV. Provider business mailing address

3512 CLARKWOOD PL
CINCINNATI OH
45208-1511
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-7122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number001527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: