Provider Demographics
NPI:1437376837
Name:GORDON, MARLA JOY (OT)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:JOY
Last Name:GORDON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:HECKENDORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2220 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3492
Mailing Address - Country:US
Mailing Address - Phone:330-929-1814
Mailing Address - Fax:
Practice Address - Street 1:130 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1701
Practice Address - Country:US
Practice Address - Phone:330-376-0334
Practice Address - Fax:330-376-1599
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH074939225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHE4158151Medicare ID - Type Unspecified