Miranda J Gordon, OTR L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT00003212 Issued in WA

Practice address

800 West Maple Street
Medical Lake, WA 99022-0800

Phone

(509) 299-3121

Fax

(509) 299-7015

NPI assigned

Jun 10, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Department of Social Dept of SHS Div of Instns

  • Psychiatric Hospital
  • Medical Lake, WA
  • NPI 1467440602
  NPD (past)
• Eastern State Hospital Pharmacy

  • Long Term Care Pharmacy
  • Medical Lake, WA
  • NPI 1679651970
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1275793671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WEST MAPLE STREET",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-299-3121",
            "fax_number": "509-299-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WEST MAPLE STREET",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-299-3121",
            "fax_number": "509-299-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MIRANDA",
        "middle_name": "J",
        "credential": "OTR L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00003212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vance Frenzel, PHARMD
• Angela M Gerry, LMT
• Christina Geschke - Lagrou, RDN, CD
• Summer Gibby, SLP
• Terry Glenn
• William H Grant, MD
• Patricia L. Gunderson, PHD
• Douglas R Gwinn, MD
• John R Henry, D.O.
• Nathan D Henry, PSYD

• Occupational Therapist in Medical Lake, WA
• Providers in Medical Lake, WA by specialty
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.