Provider Demographics
NPI:1578716726
Name:GIBAT, BERNADETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:GIBAT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FARRELL ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2619
Mailing Address - Country:US
Mailing Address - Phone:516-205-7984
Mailing Address - Fax:
Practice Address - Street 1:56 FARRELL ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2619
Practice Address - Country:US
Practice Address - Phone:516-205-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004254-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist