Provider Demographics
NPI:1225734395
Name:GOFF, KODY
Entity Type:Individual
Prefix:
First Name:KODY
Middle Name:
Last Name:GOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-8085
Mailing Address - Country:US
Mailing Address - Phone:304-679-2492
Mailing Address - Fax:
Practice Address - Street 1:71 ROSEMAR RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7657
Practice Address - Country:US
Practice Address - Phone:304-494-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator