Individual
MICHELE MARY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1075776
OR
225X00000X
Occupational Therapist
6729
NC
225XH1200X
Hand Occupational Therapist
Primary
6222
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
346512
MEDICARE PTAN
NC
Enumeration date
04/19/2006
Last updated
03/09/2020
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