Provider Demographics
NPI:1992004303
Name:GIBBS, AMY R (OTR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:GIBBS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4603
Mailing Address - Country:US
Mailing Address - Phone:214-537-0010
Mailing Address - Fax:
Practice Address - Street 1:4601 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4603
Practice Address - Country:US
Practice Address - Phone:325-793-3426
Practice Address - Fax:325-793-3463
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114118225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics