Provider Demographics
NPI:1013047968
Name:WALTON-GIBBS, DONNA (OTR L CHT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:WALTON-GIBBS
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:CAROL
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL CHT
Mailing Address - Street 1:1990 NEW DANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-9615
Mailing Address - Country:US
Mailing Address - Phone:717-291-5458
Mailing Address - Fax:717-295-3453
Practice Address - Street 1:600 EDEN ROAD
Practice Address - Street 2:BUILDING I
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4205
Practice Address - Country:US
Practice Address - Phone:717-299-4829
Practice Address - Fax:717-295-3453
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000619L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017724790004Other17