Provider Demographics
NPI:1821450867
Name:GAWANDA, CELESTE M
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:M
Last Name:GAWANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:M
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:11623 ARBOR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 N ROCK RD
Practice Address - Street 2:BUIDLING 2200, SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1341
Practice Address - Country:US
Practice Address - Phone:316-440-3316
Practice Address - Fax:888-965-6885
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-04450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant