Provider Demographics
NPI:1104452457
Name:GIBSON, KEVIN FRANCIS (OTR/L)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:GIBSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVID LN APT 8B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1118
Mailing Address - Country:US
Mailing Address - Phone:914-438-2774
Mailing Address - Fax:
Practice Address - Street 1:104 WESTERLY ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1939
Practice Address - Country:US
Practice Address - Phone:914-438-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist