Provider Demographics
NPI:1912548124
Name:SAXON, GEMMA (OT)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:SAXON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18044 UNION ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1634
Mailing Address - Country:US
Mailing Address - Phone:763-218-3154
Mailing Address - Fax:
Practice Address - Street 1:18044 UNION ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1634
Practice Address - Country:US
Practice Address - Phone:763-218-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119501225X00000X
WAOT60952395225X00000X
COOT.0004380225X00000X
344262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist