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NPI Code Detail

MEDICARE: ANDREA GIBSON MS, OTR/L

MEDICARE: ANDREA GIBSON MS, 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
1225X00000XOccupational TherapistOC016567PA
2225XP0200XPediatric Occupational TherapistOC016567PA

General Provider Information

NPI Number : 1770132227
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA GIBSON MS, OTR/L
Provider Business Mailing Address
First Line : 5621 RIVER RD
Second Line :
City : HARRISBURG
State : PA
Zip : 17110-1723
Country : US
Telephone Number : 717-433-0768
Fax Number :
Provider Business Practice Location Address
First Line : 115 S SAINT JOHNS DR
Second Line :
City : CAMP HILL
State : PA
Zip : 17011-4147
Country : US
Telephone Number : 717-761-4754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2019
Last Update Date : 03/11/2020

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