Individual
LANE D GAMBILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
1145 S CORKEY ST, WASILLA, AK 99654-7910
(907) 795-5907
Mailing address
1145 S CORKEY ST, WASILLA, AK 99654-7910
(907) 795-5907
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
04/07/2022
Last updated
04/07/2022
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