Healthcare Provider Details

I. General information

NPI: 1528998218
Provider Name (Legal Business Name): GABRIEL PURDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 JOHN DUFFY DR
JOPLIN MO
64804-1656
US

IV. Provider business mailing address

3002 JOHN DUFFY DR
JOPLIN MO
64804-1656
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 844-502-7996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024011183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: