Individual
MR. MICHAEL GOEDECKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS ATC LAT
Contact information
Practice address
603 N GRAND AVE, TAHLEQUAH, OK 74464-2302
(918) 444-3921
(918) 444-3954
Mailing address
603 N GRAND AVE, TAHLEQUAH, OK 74464-2302
(918) 444-3921
(918) 444-3954
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
957
OK
Other
Enumeration date
07/09/2014
Last updated
04/11/2017
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