Provider Demographics
NPI:1295144640
Name:GOETZ, JAMILA
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:GOETZ
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 1:1227 CASCADE CIR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4131
Mailing Address - Country:US
Mailing Address - Phone:661-733-9285
Mailing Address - Fax:
Practice Address - Street 1:1227 CASCADE CIR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4131
Practice Address - Country:US
Practice Address - Phone:661-733-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist