Individual
MALLORY LEE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 BRIM ST, DESLOGE, MO 63601-3441
(573) 431-0023
Mailing address
10637 HOPEWELL RD., MINERAL POINT, MO 63660
(573) 380-2584
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2017001953
MO
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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