Provider Demographics
NPI:1629547427
Name:GIBBONS, CAITLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:GIBBONS
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 1:21 SNEDECOR AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5332
Mailing Address - Country:US
Mailing Address - Phone:631-316-4097
Mailing Address - Fax:
Practice Address - Street 1:21 SNEDECOR AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5332
Practice Address - Country:US
Practice Address - Phone:631-316-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist