Provider Demographics
NPI:1184979759
Name:GIBBS, ANGLESHIER (COTA/L)
Entity type:Individual
Prefix:
First Name:ANGLESHIER
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17365 WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2440
Mailing Address - Country:US
Mailing Address - Phone:313-854-8868
Mailing Address - Fax:
Practice Address - Street 1:17365 WASHBURN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2440
Practice Address - Country:US
Practice Address - Phone:313-854-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202003307174H00000X
CAOTA 2338174H00000X
AZ4575174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator