Individual
MR. TERRY LEE GOHEEN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
15874 MEDORA ST, DOW, IL 62022-3173
(618) 885-5602
Mailing address
15874 MEDORA ST, DOW, IL 62022-3173
(618) 885-5602
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003047
IL
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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