Provider Demographics
NPI:1518245299
Name:GOOS, MICHAELA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:
Last Name:GOOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 S G ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2333
Mailing Address - Country:US
Mailing Address - Phone:308-750-2437
Mailing Address - Fax:
Practice Address - Street 1:224 E SOUTH E ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2649
Practice Address - Country:US
Practice Address - Phone:308-872-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist