Provider Demographics
NPI:1124726138
Name:WASHINGTON, GORDON JR
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-6336
Mailing Address - Country:US
Mailing Address - Phone:843-496-3787
Mailing Address - Fax:
Practice Address - Street 1:113 E WESTFORD RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-6336
Practice Address - Country:US
Practice Address - Phone:843-496-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist