Mary Kathleen Gordon, OTR/L
Individual provider Active NPI Occupational Therapist · Kewanee, IL
NPI 1235446261 · NPPES record last updated Sep 13, 2010
Key facts
- NPI
- 1235446261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056009143 (IL)
- Practice address
- 1051 W South St
Kewanee, IL 61443-8354 - Phone
- (309) 852-7931
- NPI assigned
- Sep 13, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056009143 | IL | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056009143 | IL | Yes |
Addresses
Primary practice location
1051 W South St
Kewanee, IL 61443-8354
Mailing address
PO Box 747
Kewanee, IL 61443-0747
Phone (309) 852-7931
Other names
- Miss Mary Kathleen Shook
Other providers in Kewanee, IL
- Josefina Foreman
- Mary Fuller
- Heather Gainey
- Philip Gambon
- Dennis J Gerleman
- Shamaila B Gorsi
- Brian D Grondin
- Heather Gustafson
- Hammond Henry Dist Hospital
- Riley Hansen
All providers in Kewanee, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.