Provider Demographics
NPI:1275864043
Name:GIBSON, TROY DALE (MS, OTR, CHT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:DALE
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MS, OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5144 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4653
Mailing Address - Country:US
Mailing Address - Phone:716-631-5224
Mailing Address - Fax:716-631-5626
Practice Address - Street 1:5144 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-4653
Practice Address - Country:US
Practice Address - Phone:716-631-5224
Practice Address - Fax:716-631-5626
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012092-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand