Healthcare Provider Details

I. General information

NPI: 1851027098
Provider Name (Legal Business Name): KATELYN GOETZMAN P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11177 LAMBS LN
NEWARK OH
43055-9779
US

IV. Provider business mailing address

11177 LAMBS LN
NEWARK OH
43055-9779
US

V. Phone/Fax

Practice location:
  • Phone: 740-763-0408
  • Fax: 740-763-0475
Mailing address:
  • Phone: 740-763-0408
  • Fax: 740-763-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013329
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: