MEDICARE: AMANDA KAY GOATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	PS 9054	OH

General Provider Information

NPI Number	:	1326297037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KAY GOATES

Provider Business Mailing Address
First Line	:	2494 PRENDERGAST PL
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-5203
Country	:	US
Telephone Number	:	801-884-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 S 30TH ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1940
Country	:	US
Telephone Number	:	740-344-0303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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Directions to “ AMANDA KAY GOATES ” Practice Location

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