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Contact Information

MARY E NORDGULEN, OTR/L, C4T
307 BOATNER ROAD
96TH MDG
EGLIN AFB, FL32542
 Phone: 850-883-8314
 Fax: 334-836-2247
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for MARY E NORDGULEN · (Female)

NPI # 1316922552
Status Active
Credentials OTR/L, C4T
Entity Individual
Enumeration date 12/09/2005
Last updated 10/17/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • AL License # 2098
  • FL License # OT1844
  • AL Medicaid 891009320
  • AL Medicaid 891009330
  • AL Medicaid 891009340
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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