Organization
OUTSIDE OT L.L.C.
Active
Organization
OUTSIDE OT L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE GORDON OTR/L (OWNER AND OCCUPATIONAL THERAPIST)
(313) 438-8816
Entity
Organization
Contact information
Practice address
63999 INDIAN TRL, RAY, MI 48096-2516
(313) 438-8816
Mailing address
63999 INDIAN TRL, RAY, MI 48096-2516
(313) 438-8816
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
OPTIONAL
MI
Enumeration date
10/13/2020
Last updated
10/13/2020
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