1124222013 NPI number — MRS. SANDRA L GAMBY-CAREY O.T.A.

Table of content: MRS. SANDRA L GAMBY-CAREY O.T.A. (NPI 1124222013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124222013 NPI number — MRS. SANDRA L GAMBY-CAREY O.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBY-CAREY
Provider First Name:
SANDRA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAMBY
Provider Other First Name:
SANDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124222013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3957 HAWTHORN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63052-1153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-296-2423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6768 N US HIGHWAY 67
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63034-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-741-9101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  004389 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com