Basic Information
| Provider Information | |||||||||
| NPI: | 1255663241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBERSON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 BLOOMFIELD AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736649899 | ||||||||
| FaxNumber: | 9736641875 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 BLOOMFIELD AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736649899 | ||||||||
| FaxNumber: | 9736641875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 02/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 46TR00036300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.