Individual
JENNIFER GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1700 E STONE ST, BRENHAM, TX 77833-5150
(979) 830-1996
Mailing address
1700 E STONE ST, BRENHAM, TX 77833-5150
(979) 830-1996
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212183
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18417962
DL NUMBER
TX
Enumeration date
01/24/2019
Last updated
01/24/2019
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