Healthcare Provider Details

I. General information

NPI: 1376437806
Provider Name (Legal Business Name): RANJITA GOSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7068 S OUTER 364
O FALLON MO
63368-7757
US

IV. Provider business mailing address

17657 GARDENVIEW MANOR CIR
WILDWOOD MO
63038-1496
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-6100
  • Fax:
Mailing address:
  • Phone: 314-329-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2010037171
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: