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Individual
MS. PHYLLIS LYNN GORDON
Active
Individual
MS. PHYLLIS LYNN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.O.T.R.
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
TR00810
NJ
225XN1300X
Neurorehabilitation Occupational Therapist
TR00810
NJ
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
TR00810
NJ
225XP0200X
Pediatric Occupational Therapist
TR00810
NJ
Other
Enumeration date
03/24/2009
Last updated
08/19/2010
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