Individual
MR. JEREMY MAC GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTR
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8085
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8085
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004355A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155238
—
IN
Enumeration date
06/29/2007
Last updated
04/30/2025
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