MEDICARE: DONNA GOFF OTR

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	171W00000X	Contractor	16819	FL
2	225X00000X	Occupational Therapist	OT16819	FL

General Provider Information

NPI Number	:	1700277027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GOFF OTR

Provider Business Mailing Address
First Line	:	8425 ALVERON AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-2407
Country	:	US
Telephone Number	:	407-617-1452
Fax Number	:

Provider Business Practice Location Address
First Line	:	8425 ALVERON AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-2407
Country	:	US
Telephone Number	:	407-617-1452
Fax Number	:

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

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	06/05/2017

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Directions to “ DONNA GOFF OTR” Practice Location

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