Provider Demographics
NPI:1932431574
Name:GOUCHER, TONYA MARIE (AS, COTA/L)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:GOUCHER
Suffix:
Gender:F
Credentials:AS, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-7000
Mailing Address - Fax:
Practice Address - Street 1:17 CROOKED CREEK DR
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:ME
Practice Address - Zip Code:04924-3354
Practice Address - Country:US
Practice Address - Phone:207-399-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1903224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant