Most Relevant Information
Provider Data
| NPI Number: | 1003581760 |
| Provider Name: | TRACEY LEE GIBBS MOT |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | OT2021-017 |
Most Important Dates
| Enumeration Date: | 08/13/2021 |
| Last Updated: | 08/13/2021 |
Provider Practice Location
605 MENA ST
MENA
AR
719533339
Practice Location Phone/Fax
| Phone: | 4793851236 |
| Fax: |
Provider Mailing Location
2356 N 9TH ST
DE QUEEN
AR
718329262
Provider Mailing Phone/Fax
| Phone: | 8707843285 |
| Fax: |