Healthcare Provider Details

I. General information

NPI: 1700338191
Provider Name (Legal Business Name): CAITLIN K GOAD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400A E 20TH ST
FARMINGTON NM
87401-9024
US

IV. Provider business mailing address

616 MESA VISTA DR
FARMINGTON NM
87401-2843
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8617
  • Fax:
Mailing address:
  • Phone: 636-288-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3576
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: