Provider Demographics
NPI:1972714509
Name:GIBSON, EVE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:EVE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 TRUBY ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9539
Mailing Address - Country:US
Mailing Address - Phone:413-467-1039
Mailing Address - Fax:
Practice Address - Street 1:43 TRUBY ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9539
Practice Address - Country:US
Practice Address - Phone:413-467-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2067313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility