MEDICARE: MADISON RAE GOETTSCH

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

General Provider Information

NPI Number	:	1912589805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON RAE GOETTSCH

Provider Business Mailing Address
First Line	:	2600 COMPASS RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3268 CASS CIR
Second Line	:
City	:	WEBSTER
State	:	MN
Zip	:	55088-2101
Country	:	US
Telephone Number	:	952-457-0637
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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Directions to “ MADISON RAE GOETTSCH ” Practice Location

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