Provider Demographics
NPI:1114775491
Name:GOODERL, KAYTLYN
Entity type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:
Last Name:GOODERL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14205 134TH RD
Mailing Address - Street 2:
Mailing Address - City:HOYT
Mailing Address - State:KS
Mailing Address - Zip Code:66440-9315
Mailing Address - Country:US
Mailing Address - Phone:785-554-8795
Mailing Address - Fax:
Practice Address - Street 1:3024 SW WANAMAKER RD STE 300
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4498
Practice Address - Country:US
Practice Address - Phone:785-272-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1704029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist