Provider Demographics
NPI:1992291637
Name:GOGGINS, KARA LYNN (COTA)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LYNN
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LYNN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10540 W ROBINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2229
Mailing Address - Country:US
Mailing Address - Phone:414-723-1556
Mailing Address - Fax:
Practice Address - Street 1:8112 W BLUEMOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3356
Practice Address - Country:US
Practice Address - Phone:414-727-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5345-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant