Dorothy Mia Gordon, OTRL
Individual provider Active NPI Pediatric Occupational Therapist · Calhoun, GA
NPI 1255408993 · NPPES record last updated Dec 8, 2021
Key facts
- NPI
- 1255408993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 001642 (GA)
- Practice address
- 1114 S Wall St
Calhoun, GA 30701-3062 - Phone
- (706) 624-3000
- Fax
- (706) 624-3001
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001642 | GA | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All About Kids Therapy Services, Inc. | Pediatrics | Past | Accepting new patients |
| Advance Rehabilitation for Kids of Gordon County, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 001642 | GA | Yes |
Addresses
Primary practice location
1114 S Wall St
Calhoun, GA 30701-3062
Mailing address
365 S Industrial Blvd
Calhoun, GA 30701-3075
Phone (706) 624-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00751308F | Medicaid | GA |
Other providers in Calhoun, GA
- Gordon County Board of Health
- Gordon County Health Department
- Gordon County Schools
- Gordon Emergency Physicians, LLC
- Gordon Health Care Center LLC
- Jimmie Callahan Goswick
- Amber Gravitt
- Pamela M Gravitt
- Phillip Gray
- Blake William Green
All providers in Calhoun, GA · Pediatric Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2021. 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.