Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1427377498 |
---|---|
Provider Name | Terra Deann Goans |
First Address | Enid, OK 73701-4027 |
Second Address | Enid, OK 73701-4027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 28/05/2010 |