Individual
DIANA L GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9132 FOX ESTATES DR, SAINT LOUIS, MO 63127-1402
(314) 753-9166
Mailing address
9132 FOX ESTATES DR, SAINT LOUIS, MO 63127-1402
(314) 753-9166
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005201
MO
Other
Enumeration date
05/09/2019
Last updated
05/09/2019
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