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General NPI Number Information
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NPI Number | 1457311953
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Entity Type | Individual
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Provider Name | ROBERT WILLIAM GORTNER OTR
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1198 SMILEY AVE SUITE F
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City | CINCINNATI
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State | OH
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Zip | 45240-1865
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Country | US
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Telephone | 513-671-6362
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Fax | 513-671-6368
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Provider Business Mailing Address
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Address Line | 6157 ROSS RD
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City | FAIRFIELD
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State | OH
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Zip | 45014-5511
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Country | US
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Telephone | 513-860-1657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-02096
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License Number State | OH
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