MEDICARE: MRS. SANDRA L GAMBY-CAREY O.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	004389	MO

General Provider Information

NPI Number	:	1124222013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA L GAMBY-CAREY O.T.A.

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

Provider Business Practice Location Address
First Line	:	6768 N US HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2742
Country	:	US
Telephone Number	:	314-741-9101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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