Provider Demographics
NPI:1912561010
Name:GIBBAR, KRISTEN N
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:GIBBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4684 LAND RUSH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2591
Mailing Address - Country:US
Mailing Address - Phone:314-398-1476
Mailing Address - Fax:
Practice Address - Street 1:4005 RIPA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2378
Practice Address - Country:US
Practice Address - Phone:314-544-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant