Healthcare Provider Details

I. General information

NPI: 1437079084
Provider Name (Legal Business Name): SHAUN E GIBSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S DOUGLAS HWY STE 100
GILLETTE WY
82716-4982
US

IV. Provider business mailing address

1211 S DOUGLAS HWY STE 100
GILLETTE WY
82716-4982
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-9191
  • Fax: 307-670-9193
Mailing address:
  • Phone: 307-670-9191
  • Fax: 307-670-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1975
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: