Provider Demographics
NPI:1932626926
Name:GOOBIC, SOPHIE C (OTR/L)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:C
Last Name:GOOBIC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3241
Mailing Address - Country:US
Mailing Address - Phone:315-854-1497
Mailing Address - Fax:
Practice Address - Street 1:110 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6299
Practice Address - Country:US
Practice Address - Phone:802-752-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0132759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist