Provider Demographics
NPI:1407494461
Name:DEVER, GORDON DOUGLAS (OTR)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:DOUGLAS
Last Name:DEVER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14412 S VIA GUALDA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8447
Mailing Address - Country:US
Mailing Address - Phone:480-734-5232
Mailing Address - Fax:
Practice Address - Street 1:14412 S VIA GUALDA
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8447
Practice Address - Country:US
Practice Address - Phone:480-734-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007482225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist