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General NPI Number Information
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NPI Number | 1538816590
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Entity Type | Individual
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Provider Name | HOLLY ANN GIBSON MOT, OTR
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 2201 N CENTRAL EXPY STE 110
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City | RICHARDSON
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State | TX
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Zip | 75080-2718
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Country | US
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Telephone | 936-444-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 SPYGLASS DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-6429
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Country | US
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Telephone | 936-444-3017
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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 | 122528
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License Number State | TX
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