Healthcare Provider Details

I. General information

NPI: 1750588992
Provider Name (Legal Business Name): WILLIAM PATRICK GIBSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12325 E GRACE AVE
SPOKANE VALLEY WA
99216-1151
US

IV. Provider business mailing address

4802 N ELTON RD
SPOKANE WA
99212-1708
US

V. Phone/Fax

Practice location:
  • Phone: 509-924-1830
  • Fax:
Mailing address:
  • Phone: 509-951-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00003548
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 00003548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: