Provider Demographics
NPI:1619103603
Name:GIBSON, JESSICA RYLANT (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RYLANT
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:RYLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:4758 GRIER RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-6105
Mailing Address - Country:US
Mailing Address - Phone:334-590-0164
Mailing Address - Fax:
Practice Address - Street 1:4209 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3601
Practice Address - Country:US
Practice Address - Phone:334-356-1020
Practice Address - Fax:334-356-2177
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2984225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist