Provider Demographics
NPI:1619049715
Name:GOFFIN, ANA LEIGH (OTR)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LEIGH
Last Name:GOFFIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 26TH ST
Mailing Address - Street 2:APT 4H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1930
Mailing Address - Country:US
Mailing Address - Phone:407-489-1680
Mailing Address - Fax:
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:IM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0129891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist