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NPI Code Detail

MEDICARE: MRS. LORA REBECCA GIBSON OTR/L

MEDICARE: MRS. LORA REBECCA GIBSON OTR/L
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
1225XP0200XPediatric Occupational Therapist3892TN
2225X00000XOccupational Therapist3380AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14289409OTHERTNBCBS
24225538OTHERTNBCBS OF TN PIN

General Provider Information

NPI Number : 1629225818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORA REBECCA GIBSON OTR/L
Provider Business Mailing Address
First Line : 1900 ALDERSGATE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6620
Country : US
Telephone Number : 501-821-5459
Fax Number :
Provider Business Practice Location Address
First Line : 1900 ALDERSGATE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6620
Country : US
Telephone Number : 501-821-5459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 02/01/2023

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