Individual
CRYSTAL D GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
RR 2 BOX 211B, BEECHER CITY, IL 62414-9208
(217) 783-2335
Mailing address
RR 2 BOX 211B, BEECHER CITY, IL 62414-9208
(217) 783-2335
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057002673
IL
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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