Provider Demographics
NPI:1497980726
Name:GATELEY, CRYSTAL AILEEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:AILEEN
Last Name:GATELEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCHOOL OF HEALTH PROFESSIONS
Mailing Address - Street 2:205 CLARK HALL
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65211-0001
Mailing Address - Country:US
Mailing Address - Phone:573-884-6239
Mailing Address - Fax:573-884-5929
Practice Address - Street 1:300 PORTLAND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65211-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6081
Practice Address - Fax:573-884-1151
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003434225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics