Provider Demographics
NPI:1891795407
Name:GOCHENOUR, TARA BETH (ATC/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:GOCHENOUR
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 HIGHWAY 54 W
Mailing Address - Street 2:BLDG 500
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4535
Mailing Address - Country:US
Mailing Address - Phone:770-461-6142
Mailing Address - Fax:770-461-6271
Practice Address - Street 1:1336 HIGHWAY 54 W
Practice Address - Street 2:BLDG 500
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4535
Practice Address - Country:US
Practice Address - Phone:770-461-6142
Practice Address - Fax:770-461-6271
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0006502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer