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General NPI Number Information
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NPI Number | 1518162577
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Entity Type | Individual
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Provider Name | DIANA LYNN GIBSON-LEE O.T.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/03/2007
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Provider Practice Location Address
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Address Line | 705 S DORT HWY
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City | FLINT
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State | MI
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Zip | 48503-2852
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Country | US
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Telephone | 810-496-5642
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 MACKINAW ST
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City | SAGINAW
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State | MI
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Zip | 48602-3031
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Country | US
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Telephone | 989-790-3277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201002605
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License Number State | MI
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