Provider Demographics
NPI:1124222013
Name:GAMBY-CAREY, SANDRA L (OTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GAMBY-CAREY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:GAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:3957 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1153
Mailing Address - Country:US
Mailing Address - Phone:636-296-2423
Mailing Address - Fax:
Practice Address - Street 1:6768 N US HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2742
Practice Address - Country:US
Practice Address - Phone:314-741-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004389224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant