Basic Information
| Provider Information | |||||||||
| NPI: | 1710328620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | KRISTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5349 PHILIPPE RD UNIT B | ||||||||
| Address2: | |||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735033295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125966585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4301 N FEDERAL HIGHWAY | ||||||||
| Address2: | SUITE 2 SOUTH BUTTERFLY EFFECTS LLC | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 08/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.