Mary Katherine Governal, C.O.T.A./L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2009014323 Issued in MO

Practice address

2 Harbor Bend CT
Lake St Louis, MO 63367-1478

Phone

(636) 965-2070

Fax

(636) 695-2080

NPI assigned

Sep 21, 2010

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": "1285027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285027200000",
    "number": "1972811149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 HARBOR BEND CT",
            "address_2": "SUITE 102",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633671478",
            "telephone_number": "636-695-2070",
            "fax_number": "636-695-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 HARBOR BEND CT",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633671478",
            "telephone_number": "636-965-2070",
            "fax_number": "636-695-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOVERNAL",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "C.O.T.A./L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-21",
        "last_updated": "2010-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2009014323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Lake St Louis, MO
• Providers in Lake St Louis, 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 Sep 21, 2010; 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.