Provider Demographics
NPI:1699181016
Name:GOLDBERG, ANDREA MARGOT (ATC, OTC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARGOT
Last Name:GOLDBERG
Suffix:
Gender:
Credentials:ATC, OTC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARGOT
Other - Last Name:BAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:357 FALLIS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3727
Mailing Address - Country:US
Mailing Address - Phone:330-701-3580
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-293-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.004837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist