Individual
MRS. TAMMY LESHAE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
175 COLONNADE CLB, HILTON HEAD, SC 29928-7804
(850) 960-1650
Mailing address
175 COLONNADE CLB, HILTON HEAD, SC 29928-7804
(850) 960-1650
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
OTA10395
FL
Other
Enumeration date
06/27/2008
Last updated
06/27/2008
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