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NPI Code Detail

MEDICARE: MS. LAURA GOODAN-GRAHAM OT

MEDICARE: MS. LAURA GOODAN-GRAHAM OT
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
1225X00000XOccupational TherapistKY-R2787KY

General Provider Information

NPI Number : 1346409505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURA GOODAN-GRAHAM OT
Provider Business Mailing Address
First Line : 7620 WOODRIDGE DR
Second Line :
City : PEWEE VALLEY
State : KY
Zip : 40056-9027
Country : US
Telephone Number : 502-241-0708
Fax Number :
Provider Business Practice Location Address
First Line : 6301 BASS RD
Second Line :
City : PROSPECT
State : KY
Zip : 40059-9384
Country : US
Telephone Number : 502-228-9440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2008
Last Update Date : 06/03/2008

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