Provider Demographics
NPI:1689688558
Name:GOOLGASIAN, BETSY E (OT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:E
Last Name:GOOLGASIAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:SUITE 5101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-741-1876
Mailing Address - Fax:561-741-1877
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:SUITE 5101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-741-1876
Practice Address - Fax:561-741-1877
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9299225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0327ZMedicare ID - Type UnspecifiedMEDICARE
FLZ0327YMedicare PIN