Provider Demographics
NPI:1134942600
Name:GORE, DALTON JAMES (COTA/L)
Entity type:Individual
Prefix:MR
First Name:DALTON
Middle Name:JAMES
Last Name:GORE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2860
Mailing Address - Country:US
Mailing Address - Phone:931-704-5064
Mailing Address - Fax:
Practice Address - Street 1:2214 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2860
Practice Address - Country:US
Practice Address - Phone:423-928-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant