Provider Demographics
NPI:1427296847
Name:GORDON, LARA HESS (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:HESS
Last Name:GORDON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7989 W VIRGINIA DR
Mailing Address - Street 2:STE. 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3837
Mailing Address - Country:US
Mailing Address - Phone:972-296-3875
Mailing Address - Fax:972-296-3575
Practice Address - Street 1:7989 W VIRGINIA DR
Practice Address - Street 2:STE. 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3837
Practice Address - Country:US
Practice Address - Phone:972-296-3875
Practice Address - Fax:972-296-3575
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110836225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand