Mallory Lee Gardner

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2017001953 Issued in MO

Practice address

801 Brim St
Desloge, MO 63601-3441

Phone

(573) 431-0023

NPI assigned

Aug 25, 2021

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 25, 2021.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1558038810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10637 HOPEWELL RD.",
            "city": "MINERAL POINT",
            "state": "MO",
            "postal_code": "63660",
            "telephone_number": "573-380-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BRIM ST",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636013441",
            "telephone_number": "573-431-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "MALLORY",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2017001953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Christopher Essmyer, D.C.
• Stephen M Forsythe, DO
• Rebecca S Francis, OTR/L
• Latasha Denise Franklin, MS, OTR/L
• Brianna Funk
• Amy Gruhala
• Haley Lerae Herbst, OTD, OTR/L
• Tasha Hollock, PTA
• Julie Danielle Hosking, P.T.
• Jeffery Linn Huck, D.C

• All providers in Desloge, MO
• Occupational Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.