Provider Demographics
NPI:1932371846
Name:GIBSON, PAULA JANE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JANE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COLSON DR
Mailing Address - Street 2:
Mailing Address - City:BRONSTON
Mailing Address - State:KY
Mailing Address - Zip Code:42518-9700
Mailing Address - Country:US
Mailing Address - Phone:606-802-2819
Mailing Address - Fax:606-678-0776
Practice Address - Street 1:29 COLSON DR
Practice Address - Street 2:
Practice Address - City:BRONSTON
Practice Address - State:KY
Practice Address - Zip Code:42518-9700
Practice Address - Country:US
Practice Address - Phone:606-802-2819
Practice Address - Fax:606-678-0776
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist