Provider Demographics
NPI:1578380648
Name:IBIM, NIAMBI (OTR/L)
Entity type:Individual
Prefix:
First Name:NIAMBI
Middle Name:
Last Name:IBIM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NIAMBI
Other - Middle Name:
Other - Last Name:IBIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4940 GOVERNORS DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4940 GOVERNORS DR STE 205
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2186
Practice Address - Country:US
Practice Address - Phone:770-742-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist