Provider Demographics
NPI:1831702638
Name:GIBBS, LORNA LORRAINE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:LORRAINE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:LORNA
Other - Middle Name:LORRAINE
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1105 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-7307
Mailing Address - Country:US
Mailing Address - Phone:918-456-8700
Mailing Address - Fax:
Practice Address - Street 1:1105 MICHAEL ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-7307
Practice Address - Country:US
Practice Address - Phone:918-456-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator