Provider Demographics
NPI:1215192513
Name:GIBSON, MARQUES ALAN (OT)
Entity Type:Individual
Prefix:
First Name:MARQUES
Middle Name:ALAN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1185
Mailing Address - Country:US
Mailing Address - Phone:334-699-2348
Mailing Address - Fax:334-699-2727
Practice Address - Street 1:3160 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1185
Practice Address - Country:US
Practice Address - Phone:334-699-2348
Practice Address - Fax:334-699-2727
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2367225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist