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General NPI Number Information
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NPI Number | 1154636546
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Entity Type | Individual
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Provider Name | SHIRLEY ANN GOSS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 02/13/2011
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Provider Practice Location Address
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Address Line | 6701 W UNION HILLS DR STE 2
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City | GLENDALE
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State | AZ
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Zip | 85308-8067
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Country | US
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Telephone | 575-494-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 6108 S LOS LAGOS CIR
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-7005
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Country | US
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Telephone | 575-494-7278
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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 | 4480
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License Number State | AZ
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