MEDICARE: MRS. JOAN CAROL GADBOIS

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	225XP0200X	Pediatric Occupational Therapist	0009	SD

General Provider Information

NPI Number	:	1518252006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN CAROL GADBOIS

Provider Business Mailing Address
First Line	:	2213 S DARTMOOR AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-0559
Country	:	US
Telephone Number	:	605-361-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 S DARTMOOR AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-0559
Country	:	US
Telephone Number	:	605-361-7889
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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