Individual
DEWANNA GOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5305 S MAPLE AVE, BROKEN ARROW, OK 74011-4213
(918) 449-0218
Mailing address
5305 S MAPLE AVE, BROKEN ARROW, OK 74011-4213
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
829
OK
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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