Provider Demographics
NPI:1699280180
Name:GIBSON, DARCIE
Entity type:Individual
Prefix:
First Name:DARCIE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48254 Y DR
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-9407
Mailing Address - Country:US
Mailing Address - Phone:541-556-0525
Mailing Address - Fax:
Practice Address - Street 1:48134 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9601
Practice Address - Country:US
Practice Address - Phone:541-556-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist