Individual
DIANE GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2000 BOARDWALK PLACE DR, O FALLON, MO 63368-3900
(618) 292-2780
Mailing address
3985 MARIETTA DR, FLORISSANT, MO 63033-3214
(314) 852-4565
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057.004125
IL
224Z00000X
Occupational Therapy Assistant
Primary
2014024930
MO
Other
Enumeration date
07/16/2015
Last updated
07/19/2015
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