Audrey Marie Gaines

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2023039702 Issued in MO

Practice address

2 Hornet Dr
Fulton, MO 65251-2732

Phone

(573) 642-4632

NPI assigned

Dec 13, 2023

Last updated

Dec 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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.

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1780452391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 COUNTY ROAD 2340",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652704323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 HORNET DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512732",
            "telephone_number": "573-642-4632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAINES",
        "first_name": "AUDREY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2023039702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fulton Medical Center LLC
• Fulton Medical Center LLC (Fulton Medical Clinic)
• Fulton Medical Center LLC (Fulton Medical Clinic)
• Fulton Residential, LLC (Churchill Terrace Assisted Living)
• Kyle Patrick Gabrielson
• Linda Jill Gamlin, PT, ATC
• George Garner, LCSW
• Kelsey Gash, ATC
• Linda Sue Gilmore
• Courtney Gragg

• Occupational Therapy Assistant in Fulton, MO
• Providers in Fulton, MO by specialty
• Occupational Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.