Provider Demographics
NPI:1225692700
Name:GIBBS, BEVERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MAPLE CARE LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8406
Mailing Address - Country:US
Mailing Address - Phone:704-871-0705
Mailing Address - Fax:
Practice Address - Street 1:1101 MAPLE CARE LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8406
Practice Address - Country:US
Practice Address - Phone:704-871-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant