Provider Demographics
NPI:1851027098
Name:GOETZMAN, KATELYN (PTA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GOETZMAN
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 1:11177 LAMBS LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9779
Mailing Address - Country:US
Mailing Address - Phone:740-763-0408
Mailing Address - Fax:740-763-0475
Practice Address - Street 1:11177 LAMBS LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9779
Practice Address - Country:US
Practice Address - Phone:740-763-0408
Practice Address - Fax:740-763-0475
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013329225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant