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General NPI Number Information
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NPI Number | 1114775491
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Entity Type | Individual
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Provider Name | KAYTLYN GOODERL
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 3024 SW WANAMAKER RD STE 300
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City | TOPEKA
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State | KS
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Zip | 66614-4498
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Country | US
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Telephone | 785-272-1535
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Fax |
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Provider Business Mailing Address
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Address Line | 14205 134TH RD
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City | HOYT
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State | KS
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Zip | 66440-9315
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Country | US
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Telephone | 785-554-8795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1704029
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License Number State | KS
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