Provider Demographics
NPI:1912306267
Name:GOOCH, MARY KATHY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHY
Last Name:GOOCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2201 COLDSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6402
Mailing Address - Country:US
Mailing Address - Phone:937-266-3429
Mailing Address - Fax:
Practice Address - Street 1:115 S LUDLOW ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1812
Practice Address - Country:US
Practice Address - Phone:937-542-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA1880224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant