Provider Demographics
NPI:1942586979
Name:GOTIEAR, JEFFREY L (CNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:GOTIEAR
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 TOWNE CT E
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2726
Mailing Address - Country:US
Mailing Address - Phone:614-622-5901
Mailing Address - Fax:
Practice Address - Street 1:326 TOWNE CT E
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2726
Practice Address - Country:US
Practice Address - Phone:614-622-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401190820111376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide