Provider Demographics
NPI:1114583986
Name:GORMLEY, SOPHIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5794
Mailing Address - Country:US
Mailing Address - Phone:401-777-7000
Mailing Address - Fax:401-459-4010
Practice Address - Street 1:285 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5794
Practice Address - Country:US
Practice Address - Phone:401-777-7000
Practice Address - Fax:401-459-4010
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist