Provider Demographics
NPI:1063488906
Name:GOAD, ANDREA LEE (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LEE
Last Name:GOAD
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 NW 69TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-948-8686
Mailing Address - Fax:405-948-8603
Practice Address - Street 1:3613 NW 56TH SUITE 202
Practice Address - Street 2:METRO HAND REHABILITATION SERVICES
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-948-8686
Practice Address - Fax:405-948-8603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT305225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1006640200Medicaid
OK376621Medicare ID - Type Unspecified