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NPI Code Detail

MEDICARE: RICKISHA GORDON

MEDICARE: RICKISHA GORDON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1629760905
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICKISHA GORDON
Provider Business Mailing Address
First Line : PO BOX 631278
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-1278
Country : US
Telephone Number : 800-356-4049
Fax Number : 941-485-0519
Provider Business Practice Location Address
First Line : 17 PARK OF COMMERCE BLVD STE 103
Second Line :
City : SAVANNAH
State : GA
Zip : 31405-7470
Country : US
Telephone Number : 800-356-4049
Fax Number : 941-485-0519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2023
Last Update Date : 05/24/2023

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Directions to “ RICKISHA GORDON ” Practice Location

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