Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC016126 | PA |
NPI | 1003477753 |
---|---|
Provider Name | Carolyn Marie Goff |
First Address | Shillington, PA 19607-1101 |
Second Address | Leesport, PA 19533-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |