Provider Demographics
NPI:1548856503
Name:GORDON, BRIANA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:10222 CAMARILLO ST APT 206
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1663
Mailing Address - Country:US
Mailing Address - Phone:818-523-0253
Mailing Address - Fax:
Practice Address - Street 1:1015 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2415
Practice Address - Country:US
Practice Address - Phone:213-607-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist