Basic Information
| Provider Information | |||||||||
| NPI: | 1821450867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAWANDA | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | M | ||||||||
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| OtherLastName: | BURGER | ||||||||
| OtherFirstName: | CELESTE | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11623 ARBOR ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442981 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 N ROCK RD | ||||||||
| Address2: | BUIDLING 2200, SUITE 101 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672261341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164403316 | ||||||||
| FaxNumber: | 8889656885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | T-04450 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.