Individual
MS. RAVEN S GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2425 ARTHUR ST, #107, GARY, IN 46404-3563
(219) 902-1498
Mailing address
2425 ARTHUR ST, #107, GARY, IN 46404-3563
(219) 902-1498
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003528
IL
Other
Enumeration date
04/23/2013
Last updated
04/23/2013
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