Individual
MR. GARY LEE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
10348 HAUBROCK RD, SUNMAN, IN 47041-8796
(812) 926-9241
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002181A
IN
Other
Enumeration date
10/03/2012
Last updated
10/03/2012
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