Provider Demographics
NPI:1093777351
Name:GIBSON, MARION K (ATC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:K
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5728
Mailing Address - Country:US
Mailing Address - Phone:541-345-7665
Mailing Address - Fax:541-342-6451
Practice Address - Street 1:1900 KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1719
Practice Address - Country:US
Practice Address - Phone:541-681-5475
Practice Address - Fax:541-342-6451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-0799882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer