Healthcare Provider Details

I. General information

NPI: 1750346920
Provider Name (Legal Business Name): MICHELE MARY GORDON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GOLDEN RIDGE RD STE 130
GOLDEN CO
80401-9541
US

IV. Provider business mailing address

660 GOLDEN RIDGE RD STE 130
GOLDEN CO
80401-9541
US

V. Phone/Fax

Practice location:
  • Phone: 303-275-2190
  • Fax:
Mailing address:
  • Phone: 303-275-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6222
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1075776
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: