Provider Demographics
NPI:1225479215
Name:GOEBBEL, LAUREN (LAUREN GOEBBEL AT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:GOEBBEL
Suffix:
Gender:F
Credentials:LAUREN GOEBBEL AT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAUREN BLOOM
Mailing Address - Street 1:3584 HOME RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065
Mailing Address - Country:US
Mailing Address - Phone:740-657-4263
Mailing Address - Fax:740-657-4297
Practice Address - Street 1:3584 HOME RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:740-657-4263
Practice Address - Fax:740-657-4297
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0024902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer