Provider Demographics
NPI:1255663241
Name:GIBERSON, MELISSA A (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:GIBERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2735
Mailing Address - Country:US
Mailing Address - Phone:973-664-9899
Mailing Address - Fax:973-664-1875
Practice Address - Street 1:75 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2735
Practice Address - Country:US
Practice Address - Phone:973-664-9899
Practice Address - Fax:973-664-1875
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00036300225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand