Provider Demographics
NPI:1922533371
Name:GARDIN, WILLIAM JR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:GARDIN
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 CAGLE CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6329
Mailing Address - Country:US
Mailing Address - Phone:704-674-6207
Mailing Address - Fax:
Practice Address - Street 1:2433 CAGLE CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6329
Practice Address - Country:US
Practice Address - Phone:704-674-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist