Individual
LARA JO GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
175 BLUEBERRY LN, LACONIA REHABILITATION CENTER, LACONIA, NH 03246
(603) 524-3340
Mailing address
14 SUMMER ST APT A, LACONIA, NH 03246-3139
(207) 942-3977
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0664
NH
224Z00000X
Occupational Therapy Assistant
OTA-1267
ID
Other
Enumeration date
11/01/2013
Last updated
11/01/2013
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