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General NPI Number Information
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NPI Number | 1881589943
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Entity Type | Individual
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Provider Name | SAMANTHA MARIE GOSCHKE CTRS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 301 N MAIN ST
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City | LAKE CITY
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State | MI
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Zip | 49651-5102
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Country | US
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Telephone | 989-899-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 4694 WALL ST
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City | SAGINAW
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State | MI
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Zip | 48638-4567
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Country | US
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Telephone | 989-751-3308
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 83884
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License Number State | MI
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