Provider Demographics
NPI:1124617840
Name:GOODIN, JANELLE RAE (COTA)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:RAE
Last Name:GOODIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 ROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-2328
Mailing Address - Country:US
Mailing Address - Phone:785-210-7656
Mailing Address - Fax:
Practice Address - Street 1:501 SE FLOWER MOUND RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6388
Practice Address - Country:US
Practice Address - Phone:580-351-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant