Healthcare Provider Details

I. General information

NPI: 1215846662
Provider Name (Legal Business Name): LUCY GASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MISSOURI ST
MACON MO
63552-2062
US

IV. Provider business mailing address

8262 LIV 245
CHILLICOTHEE MO
64601-4374
US

V. Phone/Fax

Practice location:
  • Phone: 660-395-6164
  • Fax:
Mailing address:
  • Phone: 660-973-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2024039056
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: