Provider Demographics
NPI:1508440413
Name:PAULA S. GORDY LISW, LLC
Entity Type:Organization
Organization Name:PAULA S. GORDY LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-856-2688
Mailing Address - Street 1:501 N 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1439
Mailing Address - Country:US
Mailing Address - Phone:641-856-2688
Mailing Address - Fax:
Practice Address - Street 1:501 N 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1439
Practice Address - Country:US
Practice Address - Phone:641-856-2688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty