Provider Demographics
NPI:1104236991
Name:GORDON, RUTH (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2201
Mailing Address - Country:US
Mailing Address - Phone:440-885-2351
Mailing Address - Fax:
Practice Address - Street 1:5401 W 54TH ST
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2201
Practice Address - Country:US
Practice Address - Phone:440-885-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006999225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist