Provider Demographics
NPI:1861829178
Name:GIBBS, ASHLEY R (BCBA, OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:GIBBS
Suffix:
Gender:F
Credentials:BCBA, OTR/L
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:GLEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 399318
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-9318
Mailing Address - Country:US
Mailing Address - Phone:866-523-4268
Mailing Address - Fax:
Practice Address - Street 1:11539 PARK WOODS CIR STE 250
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:678-366-5886
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005770225X00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist