Provider Demographics
NPI:1346560398
Name:GOELLNER, LAURA M (OT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GOELLNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:GERMANIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:314 CENTRAL AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2005
Mailing Address - Country:US
Mailing Address - Phone:609-365-8499
Mailing Address - Fax:609-365-8498
Practice Address - Street 1:314 CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2005
Practice Address - Country:US
Practice Address - Phone:609-365-8499
Practice Address - Fax:609-365-8498
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00517200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist