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NPI Code Detail

MEDICARE: JENNIFER GORMAN MS, OTR/L

MEDICARE: JENNIFER GORMAN MS, OTR/L
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
1225X00000XOccupational Therapist006986OH

General Provider Information

NPI Number : 1568797306
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GORMAN MS, OTR/L
Provider Business Mailing Address
First Line : 5200 MARYMOUNT VILLAGE DR
Second Line :
City : GARFIELD HEIGHTS
State : OH
Zip : 44125-2973
Country : US
Telephone Number : 216-332-1100
Fax Number :
Provider Business Practice Location Address
First Line : 5200 MARYMOUNT VILLAGE DR
Second Line :
City : GARFIELD HEIGHTS
State : OH
Zip : 44125-2973
Country : US
Telephone Number : 216-332-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2009
Last Update Date : 10/13/2009

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