Provider Demographics
NPI:1801106489
Name:GORDON, KRISTIN RAE (OTR)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:RAE
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 1:2049 RANCH GATE TRL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7794
Mailing Address - Country:US
Mailing Address - Phone:720-870-1665
Mailing Address - Fax:720-870-3827
Practice Address - Street 1:2049 RANCH GATE TRL
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7794
Practice Address - Country:US
Practice Address - Phone:720-870-1665
Practice Address - Fax:720-870-3827
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist