Provider Demographics
NPI:1114683554
Name:GORDON, SARAH N (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:N
Last Name:GORDON
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 1:402 91ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2530
Mailing Address - Country:US
Mailing Address - Phone:425-353-0455
Mailing Address - Fax:425-335-1894
Practice Address - Street 1:402 91ST AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2530
Practice Address - Country:US
Practice Address - Phone:425-353-0455
Practice Address - Fax:425-335-1894
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61202000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT61202000OtherOT LICENSE