Provider Demographics
NPI:1043514888
Name:GIBBS, LAURA JUNE (COTA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JUNE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 1ST INDUSTRY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-6083
Mailing Address - Country:US
Mailing Address - Phone:785-388-2137
Mailing Address - Fax:
Practice Address - Street 1:509 GROVE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:KS
Practice Address - Zip Code:67487-9159
Practice Address - Country:US
Practice Address - Phone:785-461-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00547224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant