Individual
MR. RYAN TERRY VAN GORDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7375
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7375
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5418
CA
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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