Provider Demographics
NPI:1003209560
Name:HIBBS, WINTER ASHLEY
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:ASHLEY
Last Name:HIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64747-8237
Mailing Address - Country:US
Mailing Address - Phone:660-924-1017
Mailing Address - Fax:
Practice Address - Street 1:503 S LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2415
Practice Address - Country:US
Practice Address - Phone:816-380-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020180224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant