Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2703 | SC |
NPI | 1255914677 |
---|---|
Provider Name | Christina Witt Gordon |
First Address | Tuscaloosa, AL 35401-1446 |
Second Address | Beaufort, SC 29907-1570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |