Provider Demographics
NPI:1386847804
Name:GOOLEY, JENNIFER ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:GOOLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:ME
Mailing Address - Zip Code:04734-0016
Mailing Address - Country:US
Mailing Address - Phone:207-227-8505
Mailing Address - Fax:
Practice Address - Street 1:94 MILITAY ST.
Practice Address - Street 2:MADIGAN ESTATES
Practice Address - City:HOLTON
Practice Address - State:ME
Practice Address - Zip Code:04730
Practice Address - Country:US
Practice Address - Phone:207-227-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2712225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant