Provider Demographics
NPI:1912297722
Name:GIBSON, LEE LOWELL (COTA/L)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:LOWELL
Last Name:GIBSON
Suffix:
Gender:M
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 1:12550 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8036
Mailing Address - Country:US
Mailing Address - Phone:206-363-7303
Mailing Address - Fax:206-826-1178
Practice Address - Street 1:12550 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8036
Practice Address - Country:US
Practice Address - Phone:206-363-7303
Practice Address - Fax:206-826-1178
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOCOOOOO764224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant