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NPI Code Detail

MEDICARE: MISS MELISSA MARIE GIBBLETS MS, OTRL

MEDICARE: MISS MELISSA MARIE GIBBLETS MS, OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOC007144LPA

General Provider Information

NPI Number : 1568580462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MELISSA MARIE GIBBLETS MS, OTRL
Provider Business Mailing Address
First Line : 47 MARKET ST
Second Line :
City : JENKINS TOWNSHIP
State : PA
Zip : 18640-1401
Country : US
Telephone Number : 570-655-1884
Fax Number :
Provider Business Practice Location Address
First Line : 23 ELLEN MEMORIAL LN
Second Line :
City : HONESDALE
State : PA
Zip : 18431-4096
Country : US
Telephone Number : 570-253-5690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 07/08/2007

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