Provider Demographics
NPI:1063643294
Name:GIBSON, PAMELA J (CLPO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CLPO
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-5505
Mailing Address - Country:US
Mailing Address - Phone:409-736-8250
Mailing Address - Fax:406-763-6863
Practice Address - Street 1:625 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5505
Practice Address - Country:US
Practice Address - Phone:409-736-8250
Practice Address - Fax:406-763-6863
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist