Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT305 | OK |
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1063488906 |
---|---|
Provider Name | Ms. Andrea Lee Goad |
First Address | Oklahoma City, OK 73116 |
Second Address | Oklahoma City, OK 73112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1006640200 | (05) | OK |