Provider Demographics
NPI:1750674305
Name:GOERTZEN, LEONIE
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:
Last Name:GOERTZEN
Suffix:
Gender:F
Credentials:
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 1771
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-1771
Mailing Address - Country:US
Mailing Address - Phone:509-720-7704
Mailing Address - Fax:509-207-7427
Practice Address - Street 1:14902 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9694
Practice Address - Country:US
Practice Address - Phone:509-720-7704
Practice Address - Fax:509-207-7427
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60119529225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics