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NPI Code Detail

MEDICARE: MS. DOROTHY MIA GORDON OTRL

MEDICARE: MS. DOROTHY MIA GORDON OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist001642GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255408993
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DOROTHY MIA GORDON OTRL
Provider Business Mailing Address
First Line : 365 S INDUSTRIAL BLVD
Second Line :
City : CALHOUN
State : GA
Zip : 30701-3075
Country : US
Telephone Number : 706-624-3000
Fax Number : 706-624-3001
Provider Business Practice Location Address
First Line : 1114 S WALL ST
Second Line :
City : CALHOUN
State : GA
Zip : 30701-3062
Country : US
Telephone Number : 706-624-3000
Fax Number : 706-624-3001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 12/08/2021

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