Individual
CHRISANNE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
660 LONDON AVE, MARYSVILLE, OH 43040-1515
(937) 578-2255
(937) 578-2268
Mailing address
660 LONDON AVE, MARYSVILLE, OH 43040-1515
(937) 578-2255
(937) 578-2268
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
35-04-2915
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000119248
ANTHEM
OH
05
—
0707328
—
OH
Enumeration date
07/10/2006
Last updated
06/25/2019
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