Individual
MISS TRACY LYNN GUMMOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
550 WHITE RD, CHESTERFIELD, MO 63017-2316
(314) 628-6101
Mailing address
1905 SUNS UP WAY, FLORISSANT, MO 63031-2787
(314) 830-1556
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005318
MO
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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