Provider Demographics
NPI:1962866319
Name:GOSE, CARLENIA IRENE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARLENIA
Middle Name:IRENE
Last Name:GOSE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 GOSE HOLW
Mailing Address - Street 2:
Mailing Address - City:MAYKING
Mailing Address - State:KY
Mailing Address - Zip Code:41837-9033
Mailing Address - Country:US
Mailing Address - Phone:606-672-1127
Mailing Address - Fax:606-672-1966
Practice Address - Street 1:130 KATE IRELAND DR
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-9071
Practice Address - Country:US
Practice Address - Phone:606-672-1127
Practice Address - Fax:606-672-1966
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOTA00220358224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant