Provider Demographics
NPI:1346409505
Name:GOODAN-GRAHAM, LAURA (OT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:GOODAN-GRAHAM
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 1:7620 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-9027
Mailing Address - Country:US
Mailing Address - Phone:502-241-0708
Mailing Address - Fax:
Practice Address - Street 1:6301 BASS RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9384
Practice Address - Country:US
Practice Address - Phone:502-228-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2787225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist