Individual
MRS. MELODY CLEMENTS GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
5381 HIGHWAY 136, TRENTON, GA 30752-2900
(706) 657-3889
(706) 657-3990
Mailing address
263 TANGLEWOOD TRL, TRENTON, GA 30752-4668
(706) 657-3891
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2551
AL
225X00000X
Occupational Therapist
Primary
929
GA
225X00000X
Occupational Therapist
OT377
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4106070
PROVIDER NUMBER
TN
Enumeration date
09/21/2006
Last updated
07/08/2007
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