Provider Demographics
NPI:1457311953
Name:GORTNER, ROBERT WILLIAM (OTR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:GORTNER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5511
Mailing Address - Country:US
Mailing Address - Phone:513-860-1657
Mailing Address - Fax:
Practice Address - Street 1:1198 SMILEY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1865
Practice Address - Country:US
Practice Address - Phone:513-671-6362
Practice Address - Fax:513-671-6368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-02096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist