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General NPI Number Information
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NPI Number | 1255397774
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Entity Type | Individual
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Provider Name | LORIE GOESER CADC, COTA, CSAC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 2448 S 102ND ST STE 340 SUITE 3
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City | MILWAUKEE
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State | WI
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Zip | 53227-2147
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Country | US
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Telephone | 414-329-2500
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Fax | 414-329-2501
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Provider Business Mailing Address
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Address Line | 727 LORILLARD CT APT 212
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City | MADISON
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State | WI
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Zip | 53703-3949
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Country | US
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Telephone | 608-215-9114
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 607-27
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1169
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License Number State | WI
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