Provider Demographics
NPI:1346880606
Name:GOETTE, DANIELLE (LMT, DOULA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GOETTE
Suffix:
Gender:F
Credentials:LMT, DOULA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BURGET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, DOULA
Mailing Address - Street 1:2590 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:541-260-4433
Mailing Address - Fax:541-808-0399
Practice Address - Street 1:320 CENTRAL AVE SUITE 226
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-260-4433
Practice Address - Fax:541-808-0399
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist