Healthcare Provider Details

I. General information

NPI: 1073801833
Provider Name (Legal Business Name): DEVON BROOKE GUCKES MSED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 RD STE 201
CHESTERFIELD MO
63005-1364
US

IV. Provider business mailing address

17300 N OUTER 40 RD STE 201
CHESTERFIELD MO
63005-1364
US

V. Phone/Fax

Practice location:
  • Phone: 636-778-2815
  • Fax:
Mailing address:
  • Phone: 636-778-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: