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General NPI Number Information
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NPI Number | 1780524975
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Entity Type | Individual
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Provider Name | CAROL ANN GORDON BSC OT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 1080 RAVOLI DR
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272
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Country | US
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Telephone | 310-230-1775
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Fax | 310-230-1874
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Provider Business Mailing Address
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Address Line | 1080 RAVOLI DR
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3917
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Country | US
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Telephone | 310-230-1775
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Fax | 310-230-1874
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | AA455014
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License Number State | CA
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