Provider Demographics
NPI:1194966630
Name:GOOTEE, TERESA SHANNON
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SHANNON
Last Name:GOOTEE
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 1:5330 LAYTHAM PIKE
Mailing Address - Street 2:
Mailing Address - City:MAYSLICK
Mailing Address - State:KY
Mailing Address - Zip Code:41055-8930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5330 LAYTHAM PIKE
Practice Address - Street 2:
Practice Address - City:MAYSLICK
Practice Address - State:KY
Practice Address - Zip Code:41055-8930
Practice Address - Country:US
Practice Address - Phone:606-763-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist