Provider Demographics
NPI:1114562469
Name:HOWARD, TANYA GOFF (OT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:GOFF
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RAVENSAIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8368
Mailing Address - Country:US
Mailing Address - Phone:985-713-9040
Mailing Address - Fax:
Practice Address - Street 1:240 RAVENSAIDE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8368
Practice Address - Country:US
Practice Address - Phone:985-713-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11421208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation