Provider Demographics
NPI:1679683551
Name:GORDON, DEBORAH GARRISON (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:GARRISON
Last Name:GORDON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 W 157TH PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3511
Mailing Address - Country:US
Mailing Address - Phone:913-897-7558
Mailing Address - Fax:
Practice Address - Street 1:6007 W 157TH PL
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3511
Practice Address - Country:US
Practice Address - Phone:913-897-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist