Provider Demographics
NPI:1295949402
Name:GIBBS, ALICIA CORONA (OTR L, MS, CHT)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:CORONA
Last Name:GIBBS
Suffix:
Gender:F
Credentials:OTR L, MS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 ROSELLE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3825
Mailing Address - Country:US
Mailing Address - Phone:760-505-2424
Mailing Address - Fax:
Practice Address - Street 1:2124 S EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6284
Practice Address - Country:US
Practice Address - Phone:760-901-5044
Practice Address - Fax:760-966-1285
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3468225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand