Gorman, Jeremy Mac

Gorman, Jeremy Mac is an sole proprietor health care provider with primary practice located at 650 Joel Dr , Fort Campbell KY 42223-5318. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as his primary health care specialty. Gorman, Jeremy Mac can be contacted via phone (931) 542-8411.

Contact Information

Primary practice address
650 Joel Dr Fort Campbell KY 42223-5318
Phone: (931) 542-8411
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X 31004355A Indiana

Profile Details

NPI number 1740487016
LBN Legal business name Gorman, Jeremy Mac
Credentials MOTR
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 29th, 2007
Last updated Feb 20th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740487016 NPPES
Indiana MEDICAID 155238

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