MEDICARE: ANDY GOODNIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	1078	OK

General Provider Information

NPI Number	:	1235760976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDY GOODNIGHT

Provider Business Mailing Address
First Line	:	16993 ELM LN
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-2837
Country	:	US
Telephone Number	:	918-527-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	16993 ELM LN
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-2837
Country	:	US
Telephone Number	:	918-527-3394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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Directions to “ ANDY GOODNIGHT ” Practice Location

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