Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT16180 | CA |
NPI | 1003352055 |
---|---|
Provider Name | Adam Gordon |
First Address | Watsonville, CA 95076-1642 |
Second Address | Aptos, CA 95003-5524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2017 |
Last Update Date | 15/01/2017 |