Provider Demographics
NPI:1699281006
Name:SHORT, GWENDOLYN MCPHAUL (ATR-BC,LCPAT)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:MCPHAUL
Last Name:SHORT
Suffix:
Gender:F
Credentials:ATR-BC,LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 RHODE ISLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6801
Mailing Address - Country:US
Mailing Address - Phone:202-652-7535
Mailing Address - Fax:
Practice Address - Street 1:914 SILVER SPRING AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4621
Practice Address - Country:US
Practice Address - Phone:301-588-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221700000X
MDAC0069221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist