Individual
JENNA GRACE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
579 BUCK ISLAND RD, YARMOUTH, MA 02673-2750
(508) 000-0000
Mailing address
579 BUCK ISLAND RD, WEST YARMOUTH, MA 02673-3200
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3543
MA
Other
Enumeration date
12/19/2012
Last updated
03/14/2013
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