Individual
TRAVIS VANDORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 652-4100
Mailing address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004808
MO
225X00000X
Occupational Therapist
056.004069
IL
Other
Enumeration date
10/02/2009
Last updated
10/02/2009
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