Lisa Ann Gibson, MOTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

31004899A Issued in IN

Practice address

1200 Barr St
Fort Wayne, IN 46802-3502

Phone

(260) 467-1110

NPI assigned

Aug 12, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281571200000",
    "number": "1477868651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 N EASTON DR",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467037566",
            "telephone_number": "260-665-8415",
            "fax_number": "260-665-8415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BARR ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023502",
            "telephone_number": "260-467-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MOTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "IN",
            "license": "31004899A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Gibson, ATC
• Alica K Gibson, MHC, MA
• Cierra Brooke Gibson, MSW
• Hope Marie Gibson
• Lindsay R Gibson, MA
• Shawn Gibson, LAC, LMSW, LPC
• Tabitha Spirit Gibson
• Tierra L Gibson, RBT
• Samuel Maina Gichuhi
• Irene Gichungeh, RN

• Pediatric Occupational Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatric Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.