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NPI Code Detail

MEDICARE: CELESTE VALERIE GIBBONS MOT, OTR/L

MEDICARE: CELESTE VALERIE GIBBONS MOT, 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 Therapist5201005658MI

General Provider Information

NPI Number : 1922585942
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTE VALERIE GIBBONS MOT, OTR/L
Provider Business Mailing Address
First Line : 13115 LAKE POINT BLVD
Second Line :
City : BELLEVILLE
State : MI
Zip : 48111-2238
Country : US
Telephone Number : 734-485-1886
Fax Number :
Provider Business Practice Location Address
First Line : 45900 GEDDES RD
Second Line :
City : CANTON
State : MI
Zip : 48188-2306
Country : US
Telephone Number : 734-879-4223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2018
Last Update Date : 07/23/2018

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