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General NPI Number Information
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NPI Number | 1154775575
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Entity Type | Individual
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Provider Name | LAUREN GOETZ
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Gender | Female
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 8665 LA MESA BLVD
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 419-779-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 3711 WILDWATER BCH APT 1
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City | MANITOU BEACH
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State | MI
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Zip | 49253-9681
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Country | US
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Telephone |
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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 | 16119
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 354972
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT010874
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 13727
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License Number State | NC
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