Individual
MRS. GINA MARIE ELMENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2120 BRYAN VALLEY COMMERCIAL DR, O FALLON, MO 63366-3495
(636) 240-8096
Mailing address
324 DALTON CT, WENTZVILLE, MO 63385-3796
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2012028513
MO
Other
Enumeration date
04/24/2013
Last updated
04/24/2013
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