Basic Information
| Provider Information | |||||||||
| NPI: | 1295215754 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GIBBS | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 W NICHOLSON ST | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788405923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307342444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HERRMANN DR | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307757477 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 209012 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.