Amanda Lee Gibson, OTRL

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

056006623 Issued in IL

Practice address

1606 Hunt Dr
Normal, IL 61761-2192

Phone

(309) 451-0069

NPI assigned

Dec 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1336204932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 BASSWOOD LN",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617615749",
            "telephone_number": "630-272-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 HUNT DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612192",
            "telephone_number": "309-451-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056006623",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IL",
            "license": "056006623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Generations at Normal, LLC
• Luke Gentry, DPT
• Gerardo a. Grieco, M.D., S.C.
• Noel Y Gerongay, RPT
• Ali Raza Ghani, M.D.
• Daniel William Gibson, D.O
• Stacey J Giese, RN
• Sherry Giles, CST
• Sydney Marie Gilmer, FNP-C
• Kayla Gingerich, CRNA

• Pediatric Occupational Therapist in Normal, IL
• Providers in Normal, IL by specialty
• Pediatric Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.