Provider Demographics
NPI:1285385393
Name:GOOMISHIAN, MICHAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GOOMISHIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OLD CANADA RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920-4005
Mailing Address - Country:US
Mailing Address - Phone:207-446-9551
Mailing Address - Fax:
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1865
Practice Address - Country:US
Practice Address - Phone:616-481-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist