Individual
JEREMY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30209 WESTWOOD DR, MADISON HEIGHTS, MI 48071-5925
(248) 250-2388
Mailing address
30209 WESTWOOD DR, MADISON HEIGHTS, MI 48071-5925
(248) 250-2388
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
117701
TX
225X00000X
Occupational Therapist
OT4646
CO
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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